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HomeMy WebLinkAbout2012-203 Contract - Terrasurvey Inc Contract for PERSONAL SERVICES less than $35,000 CITY OF CONSULTANT: Terrasurvey Inc. ASHLAND CONTACT: Richard F. Alspach 20 East Main Street Ashland, Oregon 97520 ADDRESS: 274 Fourth St. Telephone: 541/488-6002 Ashland OR 97520 Fax: 541/488-5311 TELEPHONE: 541-482-6474 DATE AGREEMENT PREPARED: 7/23/2012 FAX: BEGINNING DATE: 7/23/2012 COMPLETION DATE: 8/31/2012 COMPENSATION: NTE: $1,225.00 SERVICES TO BE PROVIDED: Create sanitary sewer access easement legal description and map for City of Ashland to access sewer trunkline through Willow Wind School. ADDITIONAL TERMS:None FINDINGS: Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the undersigned Department Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein is fair and reasonable. NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as follows: 1. Findings/ Recitations. The findings and recitations set forth above are true and correct and are incorporated herein by this reference. 2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such service. 3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel assigned to the work required under this contract are fully qualified to perform the service 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. 4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 5. Compensation: City shall pay Consultant for service 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. 6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract. 8. Living Wage Requirements: If the amount of this contract is$19,494 or more, Consultant 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 service work under this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 9. Indemnification: Consultant 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 Consultant(including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services attendant to this contract). Consultant 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. 10. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. Contract for Personal Services, Revised 06/30/2012, Page 1 of 5 . 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 Consultant, 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 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 Consultant 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 Consultant 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 Consultant's performance of each and every obligation and duty under this contract. City by written notice to Consultant of default or breach may at any time terminate the whole or any part of this contract if Consultant 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, Consultant shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Consultant 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 Consultant for work performed prior to the termination date if such work was performed in accordance with the Contract. 11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 12. Assignment and Subcontracts: Consultant 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. Consultant 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. 13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if consultant 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. 14. Insurance. Consultant 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. Professional 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 claim, incident or occurrence. This is to cover damages caused by error, omission or negligent acts related to the professional services to be provided under this contract. C. 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. d. 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. e. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or Contract for Personal Services, Revised 06/30/2012, Page 2 of 5 intent not to renew the insurance coverage(s) without 30 days' written notice from the Consultant or its insurer(s) to the City.* f. Additional Insured/Certificates of Insurance. Consultant 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 Consultant's services to be provided under this Contract. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work under this contract. 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 Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self- insurance. 15. 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 Consultant 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. Consultant, 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. 16. 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. CONSULTANT, 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. 17. Nona ppropriations 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. Consultant 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 Consultant, with no further liability to Consultant. Certification. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Consul ta City of Ashland By 7Z By �Ac,_ Signature Department Head Print Name Print Name 1(1C.r. t�.FJti' y�4( lZ Title Date W-9 One copy of a W-9 is to be submitted with / the signed contract. Purchase Order No. Contract for Personal Services, Revised 06/30/2012, 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: 1 L (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. X (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 Personal Services, Revised 06/30/2012, Page 4 of 5 CERTIFICATE OF LIABILITY INSURANCE lo1ll1zoll 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 policy(ies)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 rights to the certificate holder in lieu of such endarsement(s), PRODUCER cNW,A Julie Asher NRME: Ashland Insurance Inc PHONE , (541)482-0831 FFIC .(9411488-5851 5B5 A Street Suite 1 - EoonES S-7ashmr @ashlandinsurance.com P. O. BOX 880 - INSURERS AFFORDING COVERAGE MAIC4 Ashland OR 97520 INSURER AAssurance Company of America 19305 INSURED INSURERSNorth Pacific Ins. Co. 23892 TERRASURVEY, INC INSURERC: 274 4TH STREET INSURER D: INSURER E ASHLAND OR 97520-2044 INSURER F: COVERAGES CERTIFICATE NUMBER:CL111 011 0 3 2 6 0 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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL IN7p TYPEOFINSURANCE R POLICY NUMBER MMNUYEFF MM10131YWY LIMITS GENERALQAHILIIY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESEaocaneca S 1,000,000 A CLAIMS-MADE 1z OCCUR X PAS043357319 /10/2011 /10/2012 MEDEXP(Aymopemon) 5 10,000 PERSONAL S ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2,000,000 JFnT X POLICY PRO- LOC S AUTOMOBILE LIABILITY - COMBINED SING LIMIT 1j 000 000 Me B ANY AUTO BODILY INJURY(Parpomon) S ALL OWNED X AICJTO5ULE0 X 10151749 0/30/2010 0/30/2011 BODILY INJURY(Paruaaldanl) S HIRED AUTO$ NON_O ED 11151749 0/30/2011 0/30/2012 PPRO�nn�DAMAGE S UnInsunsdma)m)steammned S 11000,000 UMBRELLA UAB HOCCUR EACH OCCURRENCE S EXCESS LLAB CLAIMS-MADE AGGREGATE S nrD I I RETENTIONS 5 WORKERS COMPENSATION WC STAID- OTH- ANO F-NiPLDYERS'LUIBNJTY fM ANY PROPRIET(1RIPARTNERWICUDVE� NIA EL EACH ACCIDENT S OFFICER EMBER EXCLUDED? ,Mandatory In NH) EL DISEASE-EA EMPLOYE 5 If Yae,dozedba under DESCRIPTION OF OPERATIONS botaW EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(AHUh ACORD 101,AddlUonal Rnnarks Sahadula.If mom spoon,is mquimd) The City of Ashland, OR and its elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only with respect to Consultants service to be provided under this contract. CERTIFICATE HOLDER CANCELLATION (541)4B8-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Plain St. - Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Julie Asher ACORD 26(2010106) c. 2010 ACORD CORPORATION. All rights reserved. INS026(201005)Ml The ACORD name and logo are registered marks of ACORD ._ :.:.:......n..rc.;.........+.++<u-....,ora,�k"'°'.,.—�...,�.. ,.,...... a rp:A:R7::t,.;JU,.•,., s!eci2±:V..... �,. 0 PAS 43357319 1 02219246 M014993617-001-00001 NONE 0197 BRANCH Z2 50UTNERN CALIFO RENEWAL EFF 05/10/2011 ZURICH PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (CONTINUED) G01iERAG R S1� gM�3 ?t2 /}.Ka�Si'rr-a �PtJ Oj [J00N�SEMa �1. 6�.. 11 W— m ADDITIONAL INSURED—DESIGNATED PERSON OR LIABILITY ORGANIZATION NAME OF ADDITIONAL INSUREDS PERSONS ) OR ORGANIZATIONS) CG2020 0704 NAME i CITY OF ASHLAND NAME 2 ADDRESS 1 20 E. MAIN STREET ADDRESS 2 CITY ASHLAND STATE OR ZIP 9752D COMMERCIAL GENERAL UA131LTTY 9ssuo9 Ed. a•oo AGENT'S COPY 04/05/2011 7 A 7 AeoREY CERTIFICATE OF LIABILITY • INSURANCE pare. MMmom 1 10/11/2011 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 policy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER Phone: (WD)598-3700 Fax (360)598-37[13 COMACT MICHAEL J.HALL&COMPANY MICHAEL J.HALL&COMPANY HALL&COMPANY Pal�cNr a (360)598-3700 ND: (360)598-3703 _ E-mML 19660 10TH AVENUE N.E. ADDRESS: POULSBO WA 98370 c..To..ID: 1073 INSURER(S)AFFORDING COVERAGE NAIC0 INSURED Ter rasurvey Inc INSURERA Lloyd's Of London Ter 274 Fourth Street INSURER ; Ashland OR 97520 IN=U2 INa11RER p: INSURER E INSURERIF - COVERAGES CERTIFICATE NUMBER: 146811 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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, CLUSIONS AND T11 UJ MITS SHOWN MAY H INSR TYPE OF ADDL SUER POLICY Err POLICY IOU,'LTR INSR Y.YD POLICY NUMBER IAMIDO MNVDD LIMITS GENERAL LIABILITY EACH OCCURRENCE E COMMERCIAL GENERAL UABIUTY DAIMGETO RENTED PROMISES IS,aamena E . CLAIMS-MADE F—IOCCUR MED.EXP(Am,one person) $ PERSONAL&ADV INJURY $' GENERALAGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY PRO E LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per penam) $ SCHEDULEDAUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-OMEDAUTOS $ $ UMBRELLA UAS OCCUR EACH OCCURRENCE E EXCESS Me CLAIMS-MADE AGGREGATE $ DEDUCTIBLE E RETENTION $ $ [AW RKERa COMPENSATION YYC D EMPLOYFJLS WBN}Y YIN TORT LIMITS oTH E PROPRIMRa•ARTNEREXECUTNa E.L EACH ACCIDENT $ CERIMEMBER EXCLUDED? N IA a.ro,y la NM E.L.DISEASE-EA EMPLOYEE $ a,deso undtt cR1PTIONOFOPERATIONSW— E.L DISEASE-POUCY LIMIT $ A "donal Liability Claims Made Foml] 1138995321!011 02/08111 02108/12 $1,000,000 per claim Retro Date: $1,000,000 aggregate Feb 1 1999 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks schedule,IT mere space Is required) Project:Miscellaneous Surveying services CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE Attention: Jim Olson,City Surveyor Jon Becker ACORD 2 (2 009109) ©198 - 009 ACORD CORPORATION. rights reserve . The ACORD name and logo are registered marks of ACORD CITY RECORDER Page 1 /1 �. OF ASHLAND DATE PO NUMBER 20 E MAIN ST. 9/6/2012 1 1 11160 ASHLAND, OR 97520 (541)488-5300 ` o-- l VENDOR: 003354 SHIP TO: Ashland Public Works TERRASURVEY INC (541)488-5587 274 FOURTH STREET 51 WINBURN WAY ASHLAND, OR 97520 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del.Date: contact: Scott Fleury Special Inst: Confirming? NO Quantity Description Unit Price Ext.Price Create sewer access easement for City • 1,225.00 at Willow Wind Elementary School. Contract for Personal Services Beginninq date: 07123/2012 Completion date: 08/31/2012 Insurance required/On file. SUBTOTAL 1,225.00 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 1,225.00 ASHLAND, OR 97520 Account Number Project Number - Amount Account Number Project Number Amount E 675.08.17.00.60240 E 201219.100 1,225.00 AuthonzV signature VENDOR COPY _ FOR M #3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: 8/30/2012 Required date for delivery: ASAP Vendor Name Terraysurvey Inc. Address,City,State,Zip 274 Fourth St Ashland OR 97520 Contact Name&Telephone Number Richard F.Alspach 541-482-6474 Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization El 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) ❑ Slate of Oregon ® Direct Award Date approved by Council: Contract# ❑ VerbalMritten quote(s)or proposal(s) ❑ Slate of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) ❑ Other government agency contract $5,000 to$100,000 ❑ Written quote or proposal attached Agency ❑ (3)Written quotes attached ❑ Form#4, Personal Services$5K to$75K Contract# PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5.000 to$75.000 ❑ Form#9,Request for Approval ❑ Agency ❑ Less than$35,000,by direct appointment ❑, Written quote or proposal attached Date original contract approved by Council: ❑ (3)Written proposals attached Date approved by Council: (Date) ❑ Form#4, Personal Services$5K to$75K Valid until: Dale Description of SERVICES Total Cost Create sewer access easement for City at Willow Wind Elementary School. $1,225.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quotelproposal $ Project Number to(7— _- tq_ Account Number___-__-__-__-______ Account Number b7S.—0&P-X0 -(d 4M 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 signin uisition form, I certify that the City's public contracting requirements have been satisfied. Employee Signature: t Department Head Signature: 1N\XANtx-A — // (Equal to or greater than$5,000) Additional signature§-(ltappl' Funds appropriated for current fiscal year: YES / NO Finance Director-(Equal to or greater than 35,000) Date Comments: Forth#3-Requisition