HomeMy WebLinkAbout2013-047 Contract - LaLande Archeology & History Srvcs
Contract for GOODS AND SERVICES Less than $25,000
C I T Y OF CONTRACTOR: LaLande Archeology and History Services
ASHLAND
CONTACT: Jeff LaLande R.P.A, P.H.D.
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 495 Chestnut Street #8
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-778-3257
DATE AGREEMENT PREPARED: 1/15/2013 FAX:
BEGINNING DATE: 1/15/2013 COMPLETION DATE: 6/30/2013
COMPENSATION: NTE $4,500
GOODS AND SERVICES TO BE PROVIDED: City of Ashland Plaza Project-Construction site monitoring as
required by the State Historic Preservation Office (SHPO). Reference Exhibit C SHPO construction activity
monitoring letter.
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 279B.220, 2796.225, 2796.230, 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 by City under any of the following
conditions:
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, 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 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. Workers 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 06/30/2012, Page 2 of 5
intent riot 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 y begin under this contract.
21. Certificati . Contracto s II sig he certification attached hereto as Exhibit A and herein incorporated by
eferenc
Cont r: City of Ashland
By /A 1< 5E!k By
.c..Q~
Signature Department ad
1~.~bu~t 2. }-auk-E•
Print Names Print Name
~ ~Ll ao 13
i I Date
W-9 One copy of a W-9 is to be submitted with r~ /7 ~
the signed contract. Purchase Order No.
Contract for Goods and Services Less than $25,000, 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) 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.
I
i
I ~
j r
C ract " (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 5
o
f)E ' XHIRIT C
o Parks and Recreation Department
gon
re
State Historic Preservation Office
to s s John A. Kitzhaber, MD, Governor 725 Summer St NE, Ste C
Salem, OR 97301-1266
(503) 986-0671
January 14, 2013 f Fax (503) 986-0793
www: oregonheri tage. o rg
Mr. Scott Fleury JAN 1 8 2013
City of Ashalnd Public Works roaE~°N ,i Nu N,[
1C HISTORY
20 East Main Street ;
Ashland, OR 97520
RE: SHPO Case No. 12-1384
City of Ashland Plaza Re-Design Prcj
FOE/strategy & method plan for sub-surface archaeo survey/re-design existing plaza area
City of Ashland
39S IE 91313 (Main, Winburn Wy, Plaza Lp), Ashland, Jackson County
Dear Mr. Fleury:
Dr. Jeff LaLande has shared with me sufficient information for our office to comment on your proposed
project and his recommendations. In reading through Jeffs report he has made several recommendations
regarding limitations to the depth of excavations in Units 1, 2, 3, and 9. Excavations in the remaining units
(i.e., 4-8) may proceed without restriction. On-site monitoring by a professional archaeologist is required for
all ground disturbing activities in Units 1, 2, 3, and 9. Monitoring is required for all excavations that will
extend two feet or deeper in the remaining units (i.e., Units 4-8). Our office supports Dr. LaLande's
recommendations and believes that if they are followed no adverse effect to the archaeological site will
occur. Our office looks forward to receiving a copy of the final testing and monitoring report once it has
been completed. If you have any questions about any of Dr. LaLande's recommendations or any discovery,
feel free to contact my office at your convenience.
Please be sure to mention that SHPO Case# so that all correspondence can be kept together for this project.
Sincerely,
Dennis Griffin, Ph.D., RPA
State Archaeologist
(503) 986-0674
dennis.griffin@state.or.us
10/18/2012 09:06 5414884215 PAUL VOLZ INS PAGE 02/02
® DwTE(hAWDIYYW)
CERTIFICATE OF LIABILITY INSURANCE 10/18/2012
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
'=LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING (NSURER(S), AUTHORIZED
PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
nNPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polleyDes) must be endorsed. It SUBROGATION IS WAIVED. subject tD .
the terms and condition; of the p.h y, Certain pollehle may require an endonamenL A ==tamp on this cortific?tee does not Confer 6Shts to the
CeR70oate holder In Ileu of such enllors nnent(s).
PRODUCER NACONTACT
ME:
Paul W Volz Insurance Agency x.541-482-8463 ZI,ND;541-488-4215
450 Siskiyou Blvd Ste 5 h-wVuL S.0
Ashland OR 97520 NaNaF.R19) A ONOINO COYBUOE NNCY
INSURERA:Mollnt Vernon Fire
INSURED JEFFERy LALANDE INBURERB:Farmers Insurance Co of Oregon
DBA: Lalonde Archaeology s History SvC INSURER C:
495 Chesnut # 8 INSURER D:
Ashland, OR 97,520 INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIRETVIENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE 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.
LLTRR TYPE OF NSURANCE IMR ~yyp POLICY NUMBER MWDD M/DD LIMpS
GENERAL LIABILITY EACH OCCURRENCE S 1 OOO 000
X COMMERCIAL GENERAL LIABILITY PREMISES Eeoavnanca S 1DD DDD
cLAIMS4ARDE a OCCUR MEDEXP AnYoneparson S $ 000
A CL 2624317 7/2/2012 7/2/2013 PERSONALS ADV INJURY 6
GENERAL AGGREGATE S 2,000,000
GEN-L AGGREGATE LIMIT APPLIES PER PRODUCTS • COMPIOP AGG s
POLICY PRO- S
17 LOG
JECT 1 AUTOMOBILE LIABILITY I EA arodenl $
ANYAUTO BODILY INJURY(P~ Perms) $ 100,000
ALL OWNED x SCHEDULED ULED BODILY INJURY (Peragddar0 5 300, 000
B AUTOS NON-OWNED 18924-41-62 04/30/12 04/30/13
HIRED AUTOS AUTOS Per arcldan S 5010-0-0-
S
UMBRELLA LAB OCCUR EACH OCCURRENCE 6
EXCESS LAB ClA1MSJwsDE AGGREGATE 6
DED RETENTIONS S
T CST ^T O
WORKERS COMPENSATION
AND fMPLOYER3 LIABILfiY
r PROFB,ETOPTA"""'lriNE YIN EL EACH ACCIDENT 5
OFFICERM1 1T e%GIIOF99 O NIA
(NmMtar In NRI NNI E.I. DISEASE - EA EMPLOYE 6
If yc~ d scrlba wd"
DESCRIPTION OF OPERATIONS bel. E.L DISEASE - POLICY LIMB S
f
DESCRPTION OF OPER/1TIONH! LOCATIONS / VEHICLES (ABuh ACORD 101, AddWonal ft6man(a Schedule, amore spina I: eegwr14) , I-~ , jX7
City of Ashland is named as Additional insured, per contract requlreru".tQ J--
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 N Maln THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
~a u l LO Vo1Z
0198&2010ACORDCORPORATION, Allrightsreselved.
ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD
/
^!TY RECORDED Page 1 1
CITY OF ASHLAND DATE' PO NUMBER .
20 E MAIN ST. 2/28/2013 11462
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 014159 SHIP TO: Ashland Public Works
LALANDE ARCHAEOLOGY & HISTORY, SERVICE: (541) 488-5587
495 CHESTNUT ST #8 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 Unit - - Description Unit Price'-,' - :.Ext. Price
Plaza construction site monitorinq per 4,500.00
state historic preservation office
requirements.
Contract for Goods & Services
Beqinninq date: 01/15/2013
Completion date: 06/30/2013
i
SUBTOTAL 4 500.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 4,500.00
ASHLAND, OR 97520 i
Account Number Project Number Amount Account Number - Project.Number Amount.`
- I
E 110.01.02.00.60410 E 000294.999 4,500.00
i
I
Au orized Signature VENDOR COPY
FORM #3 CITY OF
A request f04 a Purchase Order ASHLAND
REQUISITION Date of request: Z l9 r
Required date for delivery:
Vendor Name 1.4t-oE t~~u~EaLOG~i 4 ulstD¢y tT--'tzultgS
Address, City, State, Zip 41lS c"ezrr.tuT- ST _ --tr 8 -ASHt4-. 1O CE . 9?S 70
Contact Name & Telephone Number Sr+t (.b.LMtpe_ Sot - a4$- s7S3
Fax Number
SOURCING METHOD
❑ 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 #
❑ VerbalNWritten quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ sole source Contract It
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 Dale approved by Council: (Date)
❑ Form 94, Personal Services $5K to $75K Valid until: Dale
Description of SERVICES. Total Cost
R-D.ZC LOt t (12uG3rG 1 5 i~E NCrtt~~ttifo
~e2 SFA1Tc iJtoit^ftlL Fa¢t~sEtZW.ReK d=~tCrE .
RelF AA~~ttTs $ Qsaa.fln
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
-TOTAL COST
❑ Per attached quotelproposal $
rnc+
Project Number 2`14 Account Number 110
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
'gni I is requisition form, I certify that the City's public contracting requirements have been satis(a
Employee Signature: Department Head Signature:
(Equal to or greaten an 5,000)
L~~ City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year YES / NO
Finance Director- (Equal to orgreater than $5,000) Date
Comments:
Form #3 - Requisition