HomeMy WebLinkAbout2012-030 Contract - Cut N Break Construction Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Cut'n Break Construction
ASHLAND CONTACT: John Lawton
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 519-B North Front StreetMedford,OR 97501
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: (541)779-1482
DATE AGREEMENT PREPARED:2/1/2012 FAX: (541)772-1913
BEGINNING DATE:Notice to Proceed date. COMPLETION DATE: 30 Days from Beginning Date.
COMPENSATION: Per Attached Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Per Attached Exhibit C.
ADDITIONAL TERMS: None.
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified,furnish all labor,equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents,that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon,are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated above
and complete the work by the completion date indicated above.
4. Compensation:City shall pay Contractor for the specified goods and for any work performed,including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to$25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents:All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2798.220, 2798.225,2796.230, 2796.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is
$18,890 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living
wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who
performs 50%or more of the work under this contract. Contractor is also required to post the notice attached hereto
as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification:Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses,judgments,subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including Joss or destruction)to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor(including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and
delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice
to Contractor, or at such later date as may be established by City under any of the following conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 2 of 7
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified,changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are no
longer eligible for the funding proposed for payments authorized by this contract;or
If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
II. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c
above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or
modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to
subsections a, b, c or d of this section, Contractor shall immediately cease all activities under this contract, unless
expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor shall deliver to City
all contract documents, information,works-in-progress and other property that are or would be deliverables had the
contract been completed. City shall pay Contractor for work performed prior to the termination date if such work was
performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification:The undersigned certifies that the undersigned Contractor has not discriminated
against minority,women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract;or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
0. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject
employers to provide Oregon workers' compensation coverage for all their subject workers
b. General Liability insurance with a combined single limit,or the equivalent,of not less than
Enter one: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury
and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
C. Automobile Liability insurance with a combined single limit,or the equivalent, of not less than
Enter one: $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property
Damage, including coverage for owned, hired or non-owned vehicles, as applicable.
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 3 of 7
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of
limits or intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its
insurer(s) to the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland,
Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies required
herein but only with respect to Contractor's services to be provided under this Contract. As evidence of the
insurance coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior
to commencing work under this contract. The contractor's insurance is primary and non-contributory. The
certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to
the City's acceptance. If requested, complete copies of insurance policies, trust agreements, etc. shall be provided
to the City. The Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions
and/or self-insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of
the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum,then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized . .
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND
EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contr r hall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
By By .� 2
igna ure Department Head
Print Name Print Name
Title Date
W-9 One copy of a W-9 is to submitted with
the signed contract._ Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 4 of 7
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
_enforceable in accordance with its.terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
v
(1) 1 carry out the labor or services at a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
/ purchased for the business.
y/ (3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor.or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) 1 assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 6 of 7
CITY OF
ASHLAND
January 3, 2012
To All Potential Bidders:
RE:Request for Quotes for Concrete and Wood Construction at Bluebird Park Entrance
The City of Ashland is seeking bidders for saw-cutting and removal of existing sidewalks and
rubble beneath the sidewalks on North Main; as well as construction of new sidewalks, wood
walls,and concrete rubble stabilization. All of the work is located on the northerly corner of the
intersection of North Main Street and Water Street in Ashland , OR,at the entrance to Bluebird t
Park.
If you are interested in submitting a bid for this work, please complete and submit the attached
Request for Quotations form to the City of Ashland Engineering Department by mail or email at
20 E. Main Street,Ashland OR 97520 or in person at 51 Winburn Way. Bids must be received
by 2:00 PM, Thursday, January 19,2012. This project will not be subject to BOLI prevailing
wage requirements.
If you have any questions regarding this request,please feel free to call me on my cell phone at
any time at(541) 326-1039.
Sincerely,
s�1
Pieter Smeenk,PE SE
vieter(@,ashland.or.us
CC: Mike Faught
Jim Olson
Morgan Waymna
Betsy Harshman
Bruce Dickens
Greg Covey
Attachments: Request for Quotention form
Drawings 1,2,and 3 of 3
Photos of site
Public Works Engineering Tel:5411488-5313
20 As l Main Oregon Fax:541/488-6006[735-2 �`,
Ashland,Oregon 97520 TTY:800!735-2900
www.ashland.or.us
G:1pub-wrks @n9tl1-32 Bluebird Park Stair Replacemenlw Admin1RFQ12012-01-11 RFQ.doc
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CITY OF
-AS H LAND
REQUEST FOR QUOTATIONS
Project is located n the northerly corner of the intersection of North Main Street and Water Street
in Ashland , OR, at the entrance to Bluebird Park. . The contractor is responsible to provide the
equipment and layout required to complete items summarized below. Please indicate your unit
costs for each of the following items indicated below.
Item Description FQty Unit Unit Price Amount
i
I Rubble removed& stabilized per LS 1
Section A-A on page I of 3
2 Sidewalks removed &replaced per Plan SF 132
Drawing on page 3 of 3 1
3 Wood Walls Replaced per elevation B- SF 150
Bon page 2of3
TOTAL=
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"-shall include all labor,concrete and incidentals(ire.pressure washer,etc.)needed to complete the work, i
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PLEASE RETURN QUOTE BY: 2:00 PM.Thursday,Januaryr 19,2012
Date:
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Signature
Address:
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Phone:
Public Works Engineering Tel:5411488-5313
20 E.Main Street Fax:541/488-6006 ,
Ashland,Oregon 97520 TTY:8001735-2900 �� I
iwww.ashland or us
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CITY OF
.- ASHLAND
I
REQUEST FOR QUOTATIONS
Project is located n the northerly coiner of the intersection of North Main Street and Water Street
in Ashland , OR,at the entrance to Bluebird Park. . The contractor is responsible to provide the
equipment and layout required to complete items summarized below. Please indicate your unit
costs for each of the following items indicated below.
Item Description Qty Unit I Unit Price Amount
1 Rubble removed &stabilized per LS 1 �1
Section A-A on page Iof3_ - _-__ -_- ��sO °�r�sO
2 Sidewalks removed&replaced per Plan SF 132 q 3 9 5 to
Drawing on page 3 of 3
3 Wood Walls Replaced per elevation B- SF 150 U a
Bon Daue 2of3 "q— 33
TOTAL= EA l o
-shall include all labor,concrete and incidentals(ire.pressure washer,e(c.)needed to complete the work.
PLEASE RETURN QUOTE BY: 2.00 PM Thursday,Janua r 19 2012
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Date: 1 °I
By:
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Public Works Engineoring Tel:5411488-5313
20 As l nd, Street Fax: 80017 5-290
Ashland,Oregon 97520 TTY:8001735-2900
tmwi.ashlancl or.us
G:lpub-wrkstengli 1-32 8lueblyd Park Slak ReplammenL%A Adm1nTFQl2012-01-11 RFQ.doc
ACCMEP® CERTIFICATE OF LIABILITY INSURANCE I DATE"°"°°" "'
`„/' a 3/2912011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer tights to the
certificate holder In Ileu of such endorsement(s).
PRODUCER NAME: Susan Wilson, AAI, AIC .
Beecher, Carlson Insurance -Agency LLC UUCNN (541)772-1111 C Ne:(5411772-3795
707 Murphy Rd ADDRESS.susan.wilson @beechercarlson.com
CCUSTOMER ID OP002 0168
Medford OR 97504 INSURER(S) AFFORDING COVERAGE NAIC0
INSURED INSURERAAmerican Hallmark Ina Co of MC 43494
Cut N Break Coaatruetion Inc; INSURER8:SAIF 5Z412
John Lawton Builders _ INSURERC:TPeatern BUXIEt
P O Box 1455 INSURERO:
INIURGRG:
Medford OR 97501-0108
COVERAGES CERTIFICATE NUMBER.:CL1132900119 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE,LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREM ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE3 PECT TO 1/1H ICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.SUER
INSR LTR TYPE OF NSURANCE POLICY NUMBER Y MMI Y LIMITS
GPmnAL UAaLm EACH OCCURRENCE f 1,000,000
X COMMERCIAL GENERAL L16VLITY PREMISES(Ea o=..l 100,000
A CIAIMS+AADE OOCCUR' 14CL44930204 4/13/2011 4/13/2022 MED EJ(P WrvarN PNSOn) f 5,000
PERSONAL d ADV INARY r 1,000,000
GENERAL AGGREGATE f 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG f 2,000,000
X POLICY PRO- LOC f
AUTOMOBLELMBILRY COMBINED SINGLE LIMIT f
ANY AUTO (Ee ec
X PY AUTO W.d)
A ALL OV.NED AUTOS 4CL44930204 4/13/2011 4/13/2012 BODILY NJURY(Per person) f
BODILY NARY(Per eecged) S
SCHEDULEDAUTOS PROPERTY DAMAGE
HIRED AUTOS IPwsu,derfl f
NON-0NNEOAUT0S Meth PeP.e is f 5,000
rm fkoa f 15,000
UMBRELLA LIAR OCCUR EACH OCCURRENCE It
EXCESS LIAR CLAMSM AGGREGATE f
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RETENTION f
B WORNERSCOMPENSAMON X WC STATU- OTH-
AMEMPLOYEWLIABILfTY YIN I TORY S1 1
ANY MOPRIETORIPARTNERIE)EDITIVE E.L.EALNACCIDENT f 500,000
O[ ICERMEA6EA FYLLIAED'! 0 NIA
IMAMtlery in NN) 89003 10/1/2011 10/1/2012 EL.DISEASE-EA EMPLOYEE f 500,000
PESC IPTION Older
DESCRIPTXIN OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT f 500 000
C BOLI Bond-Prevailing Wage 70106243 6/5/2011 6/5/2012 Uml: $30,000
(Statutory)
DESCRIPTIONOFOPQ MMILOCATONSIVEHICLES (Atlafh ACORD 1N,A44tbWrbmeMABtlw4Me,If mere sPAeehIehPl leef
Certificate holder included as additional insured (excluding work comp) pqr attached endorsement BM95390305 where
required by written contract. Subject to policy terms, conditions and exclusions.
CER71FICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIEB BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WRM THE POLICY PROVISIONS.
Kari Olson
90 N Mountain Ave AunowzEOREPRESENranve
Ashland, OR 97520
S Wilson, AAI, AIC/SU .t�,.� A-,• k/ .
ACORD 25(2009109) - ®1988-2009 ACORD CORPORATION. All rights reserved.
INS025(2oo9o9) The ACORD name and logo are registered marks of ACORD
CITY RECORDER Page 1 / 1
CITY OF
�S.H LAN D DATE PO NUMBER
20 E MAIN ST. 2/14/2012 10684
ASHLAND, OR 97520
(541)488-5300
VENDOR: 004823 SHIP TO: Ashland Public Works
CUT N' BREAK CONSTRUCTION INC. (541)488-5587
P O BOX 1455 51 WINBURN WAY
MEDFORD, OR 97501 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.:
Req.Del.Date: Contact: Pieter Smeenk
Special Inst: Confirming? NO
:Ouanti ?Unit Descri lion - Unit P'rice-'- EA.Price < '
Bluebird Stair Installation 9,610.00
Per attached drawings, proposal and
contract
Contract for Goods and Services
Beginning date: February 15, 2012
Completion date: March 15, 2012
Note: Beq/Completion dates per Pieter
on February 14, 2012
Insurance required/On file
SUBTOTAL 9,610.00
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 9,610.00
ASHLAND, OR 97520
Accounf Number Project Number . Amount Account Number Project"Number j Amount
E 260.08.12.00.704200 E 201132.120 9,610.00
VENDO
Aut orized signature
VENDOR COPY
F:M1Vi #3 CITY OF
n R ASHLAND
REQUISITION [ 11�/! Date of request: � ?S 20�L .
Required date for delivery:
Vendor Name ,
Address,City,State,Zip PO R13
contact Name&Telephone Number M en
Fax Number _ 33
SOLICITATION PROCESS
Exem ttffrom Competitive Bidding Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached
Small Procurement CCoo- er�ative Procurement
Less than$5.000 ❑ Request for Proposal (Copies on file) State o� f Oregon
Note:Total contract amount,including any Date approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement LJ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5.000 to$100.000 ❑ Quote or Proposal attached Agency
(3)Written quotes attached Contract#
P RSONAL SERVICES LJ Special Procurement ❑ Intergovernmental Agreement
$5 000 t-o$75 00000- ❑ Written Findings(Form attached) Agency
Lest s than$35;000,b direct appointment Contract#
Y PP ❑ Quote or Proposal attached
El (3)Written proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
See a shed �'IeS4
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL:COST
❑ Per attached quotelproposal S
ProjectNumber?2Ol 1--- 32 Account Number A'ba -oa-13-7o` A00 -
Account Number___-__-__-__•______ Account Number___-__-__-__-______
'Expenditure must be charged to the appropriate account numbers for the financiats to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
ITDirector Date
By signing this requisition form,I certify that the information provided above satisfies the City's public contracting requirements,and the documentation can be
provided upon request.
Employee Signature: zPeQe j� Department Head Signature:
Additional signatures(if applicable):
Funds appropriated for current fiscal year Y S%NO
G:FinanceTrocedurel4PlFormslFonn%233-Requisition.doc Updated on:1/16/2012