HomeMy WebLinkAbout2012-033 Contract - JM Construction Inc Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: JM Construction Inc.
ASHLAND CONTACT: Jay Meyers
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 1637, Shady Cove, Or 97539
Telephone: 541/488-6002
Fax: 5411488-5311 TELEPHONE: 541-878-7810
DATE AGREEMENT PREPARED: February 16 2012 FAX: 541-878-7811
BEGINNING DATE: February 21, 2012 COMPLETION DATE: February 24, 2012
COMPENSATION: .$1,750.00—Per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Contractor to excavate 85' ditch at 36" depth and install 3"
PVC electrical conduit for underground electrical service and compact ditch with sand and W minus aggregate
per proposal attached as Exhibit C. City to provide 3" PVC electrical conduit.
ADDITIONAL TERMS:
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 awn 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 279B.220, 2798.225, 279B.230, 2798.235, 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 loss 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:
Contract for Goods and Services Less than$25,000, Revised 06/3012011, Page 1 of 5
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
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
iii. 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 to 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:
a. 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.
d. Notice of cancellation or change. There shall be no cancellation material change, reduction of limits or
Contract for Goods and Services Less than$25,000,Revised 06/30/2011, Page 2 of 5
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 contractors 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. Nonappropriatfons 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. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
B ff\� By .dye
S' nature Department Head
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Print Name Print Name
TV%F1StDFIMT
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 06/30/2011,Page 3 of 5
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.
(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 Q (D te)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011,Page 4 of 5
°z P.O.Box 1637
Shady Cove,Oregon 97539
(541)878-7810 Fax:(541)878-7811
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PROPOSAL & CONTRACT
Date: February 16,2012
Proposal Submitted To: Dave Tygerson
City of Ashland—Electric Department
90 North Mountain Avenue
Ashland, Oregon 97520
Phone: (541)488-5357 Fax: (541) 552-2436
Email: davet @ashland.or.us
PROJECT SITE: Ashland Lumber
Oak Street,Ashland,Oregon 97520
REFERENCE MATERIALS: Walk-through of project site with Dave Tygerson
(Ashland)and Jay Myers (JMC).
WE PROPOSE hereby to furnish labor and materials as detailed below in the lump sum of
ONE-THOUSAND, SEVEN HUNDRED FIFTY DOLLARS ($1,750.00):
Provide ditch from hand pull to the existing shed for underground power.
Approximately 85 if of ditching for underground power.
All materials excavated to be removed from site and all sand and 3/4"minus aggregate to
be placed and compacted in ditch.
Conduit to be provided by Ashland Electric.
JM Construction Inc. is aware that the financial responsibilities are to be split equally
between the City of Ashland($1,750.00)and Ashland Lumber($1,750.00).
THIS PROJECT IS NOT BID AS A PREVAILING WAGE PROJECT.
EXCLUSIONS: Engineering and Sail Testing
Permits and Fees
Surveys and Locates
Barricades and Temporary Fencing
Landscaping and Irrigation
Topsoil
Conduit
Proposal—City of Ashland Elect—Ashland Lumber I of 3 February 16,2012
P.O.Box 1637
C Shady Cove,Oregon 97539
(541)878-7810 Fax:(541)878-7811
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PAYMENT TERMS: Progress invoices will be supplied by JM Construction Inc, at the end of
each month and shall be paid by the customer no later than the 101h of the subsequent month.
Any amounts and/or balances in arrears more than thirty(30)days will be subject to 2%per
month interest.
DISCLOSURES: All material is guaranteed to be as specified. All work to be completed in a
workmanlike manner according to standard practices. Any alteration of deviation from above
specifications involving extra costs will be executed only upon written orders, and will become
an extra charge over and above the estimate. However, JM Construction Inc. shall not be
deemed to have waived its right to compensation for extra work if the extra work was not
provided for in writing,but shall be paid the reasonable value for such work performed. All
agreements contingent upon strikes, accidents or delays are beyond our control. Any dispute or
controversy arising out of the terms, conditions, or requirements of this agreement which exceed
$4,000.00 in possible damages shall be submitted to arbitration in accordance with the American
Arbitration Association Construction Industry Arbitration Rules and judgment rendered by the
arbitrator shall be entered into any court of competent jurisdiction. The prevailing party in any
suit or action or arbitration or administrative proceeding(including Construction Contractors
Board Claims) brought under the terms of this agreement to enforce or interpret any provision
herein, shall be awarded attorneys fees and costs as may be adjudged reasonable by the
Arbitration panel,administrative authority, court, or appellate court. Owner to carry fire,
earthquake and other necessary insurance. Our workers are fully covered by Workman's
Compensation Insurance.
Differing Site Conditions: Any undisclosed or unforeseen subsurface conditions that arise upon
excavation that are not deemed"standard" shall be considered above the contract price and shall
be converted to time and material for all extra conditions. (e.g, any soils unable to be excavated
with a typical backhoe, excavator, etc.)
Linear and/or Square Footage Totals: Actual quantities shall be verified between the customer
and a JM Construction Inc. representative upon project completion if necessary.
WARRANTY: Warranty and/or guarantee period shall be the standard one(1)year from the
date of substantial completion of this project. This warranty is valid only when the property or
its improvements are subject to normal use and care by the Customer and provided the Customer
has fully complied with all the terms and payment provisions of this agreement. JM
Construction Inc. reserves the right to repair,replace,or pay reasonable sum in order to affect
any mutual acknowledged repairs or corrections both during the construction process and
throughout the warrantee period.
Proposal—City of Ashland Elcct—Ashland Lomber 2 of 3 F&b .y 16,2012
P.O.Box 1637
Shady Cove,Oregon 97539
(541)878-7810 Fax:(541)878-7811
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Note: This proposal may be withdrawn by us if not accepted within seven (7)days.
JMConstruction Inc./Authorized Signature
ACCEPTANCE OF PROPOSAL--The above prices, specifications and conditions are
satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment
will be made as outlined above.
I
Date ofAcceptance ,2012
Customer/Signature
Customer/Print Name and Title
Proposal—City of Ashland Elect—Ashland Lumber 3 of 3 February 16,2012
www.salf.com
OREGON WORKERS COMPENSATION -� saiF
CERTIFICATE OF INSURANCE Jcorporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
90 N. MOUNTAIN AVENUE
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated. The Insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
948875 12/01/2011 to 12/01/2012 02/16/2012
INSURED: BROKER OF RECORD:
]M CONSTRUCTION INC
PO BOX 1637
SHADY COVE, OR 97539-1637
LIMITS OF LIABILITY:
Bodily Injury by Accident $1,000,000 each accident
Bodily Injury by Disease $1,000,000 each employee
Body Injury by Disease $1,000,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
ALL OPERATIONS
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the policies above.
AUTHORIZED REPRESENTATIVE
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President and CEO
400 High Street SE
Salem,OR 97312
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. 02/16/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CCCTICICATC DOCS NOT ACCIGMATIVCLV OR NCCATIVCLV AMCND, CYTCND OR ALTCC TYC COVCCACC ACCOGDCD CV TYC GOLICICS
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REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANI: It e certificate holder is an ADDI I IONAL lNbURED.the po Icy les most a endorsed. _ ,SLIblect to
the term,and condition,of Inc,policy,certain policies may require an endonemcnt. A,talement on thin ecitificote doc,not confer Rpht3 to the
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PRODUCER NAME:
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1998 skypark Dr Suite 100 ADDRESS:
Medford OR 97504 .Is,OHCnl.� .TMMN—T
Phone:5.41-779-0177 Fax:FAX 772-8235 INSURER(S)AFFORDING COVERAGE NAIL It
INSURED INSURERA: Onio Security 24U'l4
JM Construction Inc. INSURER B:
Deborah Myers
PO BOX 1637 INSURER C:
Shady Cove OR 97539
INSURER D
INSURER 9:
INSURER F:
COVCRACCS CCRTIFICATC NUMOCR: RCVICION NUMOCR:
THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 13SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AddRlonal Ramarka 9chalule,If many waca It.n qulrad)
The City Of Ashland, Orcgon and its cicctcd Off icia a of£a.ccra sad
employees are additional insured per form CG8810 10/09
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Kari Olson ACCORDANCE WITH THE POLICY PROVISIONS.
fuJ.vlaa.+iaay Acy,_c-�caaLi�c
City of Ashland AUTHORIZED REPRESENTATIVE
90 N Mountain Ave
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Oa 1988-2009 ACORD CORPORATION. All rights reserved.
ACUKU LD(YUUHIUy) I ne ACUKO name and logo are reglSLerea marKS 01 AL:UKU
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20 E MAIN ST. 2/21/2012 10696
ASHLAND, OR 97520
(541)488-5300
VENDOR: 010109 SHIP To: Ashland Electric Department -
JM CONSTRUCTION INC (541)488-5354
PO BOX 1637 90 N MOUNTAIN
SHADY COVE, OR 97539 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.:
Req.Del.Date: Contact: Dave Tygerson
Special Inst: Confirming? No
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Contractor to excavate 85'ditch Cd?36” 1,750.00
depth and install 3" PVC for electric
service
Contract for Goods and Services
Beginning date: February 21, 2012
Completion date: February 24, 2012
Insurance required/On file
SUBTOTAL 1750.00
BILL To:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 1,750.00
ASHLAND, OR 97520
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E 690.11.18.00.704100 E 000264.999 1,750.00
Authorized SignatGre VENDOR COPY
FORM #3 CITY OF
ASHLAND
REQUISITION Date of request:
Required date for delivery:
Vendor Name M CDNSTRL1�Tl�ti
Address,City,State,Tip P.Q. 13OX 1 637 SHgLY CYaf2 (A A—/5?q
Contact Name&Telephone Number .54 1 • 11978 - 7910 FAA : Sk 1 •$79 • 791 1
Fax Number
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SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Date approved by Council: Contract#
❑ Verbal/Written quote(s)or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5,000 to$100,000 ❑ Written quote or proposal attached Agency
❑ (3)Written quotes attached ❑ Special Procurement Contract#
PERSONAL SERVICES ❑ Written Findings(Form #9 attached) Intergovernmental Agreement
$5.000 to$75,000 ❑ Written quote or proposal attached ❑ Agency
❑ Less than$35,000,by direct appointment Date approved by Council: Date original contract approved by Council:
❑ (3)Written proposals attached I Valid until: Date (Date)
Description of SERVICES Total Cost
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Item# Quantity . Unit Description of MATERIALS Unit Price Total Cost
Sy' -trenck 50.00
TOTAL COST
Q Per attached quotelproposal $
Project Number__ 'y-?99' Account Number( 94-11-IWOD-ZU!UDD
Account Number Account Number
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
ITDirector Date Support-Yes/No
By signing this requisition form,I certify that the Cdy's public contracting requirements have been satisfied.
Employee Signature: ,I ,(AAA. YOJ Department Head Signature:
(Equal to or greater tha ,000)
Additional signatures(if applicable):
Funds appropriated for current fiscal year: Q/ NO ,/�/ z
Finance Director-(Equalloorgreater anS5000) Date
Comments: