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HomeMy WebLinkAbout2012-283 Contract - JT Electric F' Contract for GOODS AND SERVICES Less than $25,000 'CITY OF CONTRACTOR: J. T. Electric Inc. ASHLAND CONTACT: Jeremy Richmond 20 East Main Street Ashland, Oregon 97520. ADDRESS: 4849 Airway Drive, Suite 105, Central Point, Telephone: 541/488-6002 Oregon 97502 Fax: 541/488-5311 TELEPHONE: 541-734-5714 DATE AGREEMENT PREPARED: October 25, 2012 FAX: BEGINNING DATE: October 29, 2012 COMPLETION DATE: November 9, 2012 COMPENSATION: $2,390.00 per proposal attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Contractor to relocate existing overhead service to anew underground source at 410 N. Main Street. Service to be installed per NEC standards and proposal attached as Exhibit C. 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 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 279B.220, 279B.225, 2798.230, 279B.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 $19,494 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 b City under an of the following Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 1 of 5 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 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: 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. t Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 2 of 5 `I 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. 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. 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 oM:1 n/ BY BY Signature vt~ De rtment Head l/ rint Name Print Name A^ kz_ Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. I i Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 3 of 5 n 3 EXHIBIT A i 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 3 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: J~ (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 j . 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. l (5) Labor or services are performed for two or more different persons within a period of one year. IL (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. i JT ~lt~f~Y~ ln~ q'2H-l~'. Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 5 PROPOSAL IT Electric, Inc Date Proposal # 4849 Airway Dr Suite 105 Central Point, Or 97502 J L . E C T R I C 10/18/2012 961 CCB # 156168 COMMERCIAL- RESIDENTIAL (541) 734-57 1 4 Name / Address City Of Ashland Electric Dept. 90 N Mountain Ave Ashland, OR 97520 PROJECT COLWELL CHIROPRACTIC Description Total PERFORM MISCELLANEOUS ELECTRICAL TASKS PER WALK THROUGH AND PER NEC STANDARDS TO 2,390.00 INCLUDE THE FOLLOWING 1. Dig 3' deep trench from vault to new 24"x36" junction box location & install 3" PVC conduit (located aprox. 15' away) 2. Install new 24"X36" sealablejurrction box 3. Install 400 amp feeder from new junction box over 25' and up to a level of 1' above roof (parallel 200 amp feeds installed in 2" amt conduit) NOTES 1. Permit fees included 2. Trenching & backfill included 3. Underground feeder & installation by Ashland Power 4. Price good for 60 days Please call with any questions TO`d' 1 ` $2,390.00 We propose to famish all labor & materials in accordance to specifications listed above. By signing and returning this proposal, customer agrees to the terms, conditions and specifications. Customer hereby enters into a legal binding contract with the contractor and guarantees payment for all supplies and services tendered. Accepted By: Date: '2012 9:V PM (GMT) From: Ashland Insurance Inc 541-488-5851 To: 15414885320 Page 2 of 2 DATE (MMOD(YYYY) oR CERTIFICATE OF LIABILITY INSURANCE 9/24/2012 S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND_CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ¢TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES _OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. subject to r( RTANT: If the certiRcate holder Is an ADDITIONAL INSURED, the pallcy(les) must be endorsed. If SUBROGATION IS WAIVED, 1 terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the tincate holder In'lleu of such endorsement(s)- PAMOTEjulic Julie Asher JCER - - (541)982-0831 apixe Na: ISdLl aea-s.SL land insurance Inc A Street Suite 1 jashe,r@ashlandinsurance. cam O INSURER ANAI C 9 . Box 880 land OR 97520 American States Insurance Co 19704 ISO a:SAIF CO ration ELECTRIC INC C: 9 AIRWAY OR STE 105 O: E, JTRAL POINT OR 97502 INSURER F: /ERAGES CERTIFICATE NUMBER:CL1272323GSO REVISION NUMBER: IIS IS TO CER TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATEO. NOTMTHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS D BY THE POL INSURANCE AFFORD DESCRIBED (CLUSIONS NDYCONDITIONS OF UCH POLICIIEB LIMITS SHOWN MAY H VEESEEN REDUCEEDI BIY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, ERTIFICATE BE ISSUED POLICY EFF POLICY E(P LIMITS TYPE OF INSURANCE FOUCYNUMBER MMIDONYV MMMONYYY 1,000 000 EACH OCCURRENCE S r GENERAL LIABILITY av X COMMERCIAL GENERAL LIABILITY PREMISES SO..v ,ca S 200,000 CLAIMS-MADE /1/2012 - /1/2013 MED EXP(Any ma Person) S 10,000 ❑X OCCUR X 1Cft1fi914170 - PERSONAL & AOV INJURY B 1,000,000 GENERAL AGGREGATE s 2,000,000 PRODUCTS-COMP,OP AGG S 2,000,000 GENT AGGREGATE LIMB APPLIES PER: g X POLICY PRO- LOG COMBINED SINGLE LIMIT AUTOMOBILELIABILITY E. .c ldenl S BODILY INJURY (Per parson) S ANY AUTO BODILY INJURY (Far..Idani S A OS SCHEDULED AUTOS AUTOS PROPER DAMAGE 5 NON-OWNED Par.= dent HIRED AUTOS AUTOS S EACH OCCURRENCE S UMBRELLA LIAR OCCUR AGGREGATE S EXCESS LIpa CLAIMS-MADE 5 DEn PETE TIONS - WG STATU- OTH- WORXERS COMPENSATION ANIJ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 5 500 000 ANY PROPRIETORFARTNERIF.%ECUTIVEYIN NIA OFFICERIMEMBER EXCLUOEDT 63287 /1/2012 11/2013 EL DISEASE - EA EMPLOYE S 500 000 IMandalury In NH) Ir EL DISEASE-POLICY LIMIT 5 500 000 m DESC describe RIPTION under OF OPERATIONS below iSCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Rnnads ....dul0, Ir mom gpao010 repulmdl ity of Ashland is listed as an, additional insured. '.ERTIFICATE HOLDER \ CANCELLATION . 541) 488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City o£' Ashland 90 N Mountain Ave AUTHORIZED REPRESENTATIVE Ashland, OR 97520 01n Julie Asher V © 9 -2010 ACORD CORPORATION. All rights reserved. 25 aCORD (2010105) N5025 r201 oa5LDl The ACORD name and logo are registered mar s of ACORD /2012 9:57 PM (GMT) From: Ashland Insurance Inc 541-488-5851 To: 15414885320 Page 1 of 2 :ollowing is the,Certificate of Insurance forJT Electric. fu//e Asher - Ish/and Insurance Inc 10 Box 880 7sh/and OR 97520 -hone(54f)482-0831 maxi (541)488.5851 a mach jashergashlandinsurance.com %%%%#*+Y+Y%%##%%rtrtrtW**i%rtrt%%#%%%rtrtrtrtrt%rtrtrtfiWW%%%*%%%%%%%rtrt*%**%WW%%%rt%%%%rt Olease remember that coverage cannot be bound, amended or cancelled via the voice mail or a-mail system. Coverage .annot be assumed to be bound without written confirmation from an authorized representative of Ashland Insurance nc. :ONFIDENTIALITY NOTICE he information contained in this communication, including attachments, may contain privileged and confidential information that s intended only for the exclusive use of the addressee. If the reader of this message is not the intended recipient, or the employee x agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us by telephone mmediately 10/08/2012 MON 14:24 FAX 5417737678 SOPTA 0002/002 Commercial Certificate of Liability Insurance FARMERS: Agency Joe Rayburn Issue Date (MM/DD/YY)I- 09/24/12 Name 3619 Aviation Way Ste 101 This Certificate is issued as a matter of information only and confers no rights & Medford, OR 97504-9830 upon the certificate holder. This certificate does not affirmatively or negatively Address 541-772-6107 amend, extend or alter the coverage afforded by the policies shown below. St. 73 Dist. 01 Agent 341 This certificate of insurance dues not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder. Insured J T Electric, Inc Companies Providing Coverage (NAIC li): Name 4849 Airway Drive Company Letter A Truck Insurance Exchange 21709 & Central Point, OR 97502 Company Letter B Farmers Insurance Exchange 21652 Address - - Company Letter C Mid-Century Insurance Company 216871 Company Letter D _ Coverages 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 b aid claims. Co. Addl Type of Insurance Policy Number polity Elieclive Policy Expiration Ur. insrd. Y Dale(NM/oo/n9 Date(MM/oo/M Policy Limits General Liability Each Occurrence $ T-Commercial General Llab. _ Businessowners Liability Damage Tiii? Rented $ Premises (ba. Occur.) I Vical Expens s $ -Claims Made ( ny one person -Occurrence Personal & Adv. Injury General Aggregate Limit Applies: General Aggregate $ / - - _ Per Location -i Prod./Corny. Ops. Aggr. $ Per Protect Automobile Liability Combined Single Limit $ _Any Auto (Each accident) C All Owned Autos 034984073 07/12/12 07/12/13 Bodily Injury $ 100;000 -X Scheduled Autos (Per person) -Hired Autos Bodily Injury $ 300,000 _ Non -Owned Autos (Per acclddeni) Propertcdey Da age $ 50,000 i (Per acnt Garage Liability Auto Only-Ea. Accident $ Any Auto Other Than Each Accident $ Auto Only; Aggregate $ Umbrella Liability Retention S Limit $ Workeri Compensation and Statutory Employers Liability Each Accident $ Disease - Ea. Employee $ Disease - Polley Limit IS _ Description of Operations/Vehicles/Restrictions/Special items: Certificate Holder Cancellation Should any of the above described policies be cancelled Name City of Ashland before the expiration date thereof, notice will be delivered in & 20 East Main Street accordance with the policy provisions. Address Ashland, OR 97520 L Authorized Re eseve 56-2492 10.11 02492201 PAfE I a 2 Y REVV -JL;C Page 1 / 1 DATE PO NUMBER MIA ASHLAND Crrv OF S~ 20 E MAIN ST. 11/14/2012 11289 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 017313 SHIP TO: Ashland Electric Department JT ELECTRIC INC (541) 488-5354 4849 AIRWAY DRIVE SUITE 105 90 N MOUNTAIN CENTRAL POINT, OR 97502 ASHLAND, OR 97520 FOB Point: Req. No.: Terms: Net Dept.: Req. Del. Date: contact: Dave TVgerson Special Inst: confirming? No Quantity Unit Description Unit Price Ext. Price Contractor to relocate existinq O.H. 2,390.00 service to new underground source (a. 410 N. Main Street service to be installed per NEC standards. Contract for Goods and Services Beginning date: October 29, 2012 Completion date: November 9, 2012. Insurance required/On file SUBTOTAL 2 390.00 BILL To: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 ASHLAND, , O OR 97520 TOTAL 2,390.00 ASHL Account Number Project Number Amount Account Number Project Number Amount E 260.08.12.00.70420 E 200205.999 2,390.00 Autho ed Signature VENDORCOPY F6RM#3 CITY OF ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name -777- f-::-1-C(-7P1C -ZIVC - Address, City, State, Zip 1-.1 C/ j 411?tui-9 y , DA InS Contact Name & Telephone Number Fax Number zl IWC7 /JA E /C1-19 /2 SOURCING METHOD 061 l-0774CV l~HT~ //-c1 -/2 ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ 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 8 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 E] Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Form #g,Request forApproval ❑ 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 untl: Date Description of SERVICES Total Cost A-4-4004-7- Fi!/a'T/NC- C 1t• 5~/2Vilf= ro Ncct/ i./rI/dr~ JrG✓irc/ cr'iiTG///O V 197141ti 6r' c~/3~~ c?>n SCi2V/r,~ F 7z' i3r= //✓.Sr~Cu rl ~ N.eC-' 6 rAA10if 4~ 5 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal ; p0 Project Number«'1 - O t:; Account Number260- OA /:Z- CIO- 70,1420 0 0?/ 3`/c'7r 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: IT Director Date Support -Yes/ No ~By~signing this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee Signature:, I C:V1_L_ ~ 1GClf GCL((l'l - Department Head Signature: l (Equal to or greater than $5,000) Additional signatures (if applicable): Funds appropriated for current fiscal year YES / NO Finance Director- (Equal to orgrealer than 55,000) Date Comments: