HomeMy WebLinkAbout2013-099 Contract - David Evans & Associates
Contract for PERSONAL SERVICES less than $35,000
CITY OF CONSULTANT: David Evans and Associates, Inc.
ASHLAND CONTACT: Craig Sheahan
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 2100 SW River Parkway, Portland, OR 97201
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 503-805-3962
DATE AGREEMENT PREPARED: 4/2/2013 FAX:
BEGINNING DATE: 4/2/2013 COMPLETION DATE: 4/2/2014
COMPENSATION: Not to exceed $10,000.
SERVICES TO BE PROVIDED: Plan review and construction inspection on an as-needed basis.
ADDITIONAL TERMS: N/A
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 to the extent arising out of or incident to the negligent 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, to the extent directly, solely, and proximately caused by
the negligence of City.
10. Termination:
a. Mutual Consent. This contract may be terminated at an time b mutual consent of both parties.
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I -
b. Citvs Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
I 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
I written notice to Consultant, or at such later date as may be established by City under any of the following
conditions:
L 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 parry 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
B 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
r 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
h 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
I 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 negligent acts or omissions related to the professional services to be provided under
this contract.
I C. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
t $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 as per ISO CG 00 01 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.
i D:\My Documents\Work\Pursuits\Ashland\DEA Contract 20130408.docx
e, 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 Consultant 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 the general liability and auto insurance policies
required herein but only with respect to Consultant's services to be provided under this Contract. The consultant's
general liability and auto insurance is primary and non-contributory. As evidence of the insurance coverages
required by this Contract, the Consultant shall furnish ACORD 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 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. 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. 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.
Certificatio . Consultants II sign the certification attached hereto as Exhibit A and herein incorporated b reference.
onsulta City of Ashland
By <5 By
Signature Department ea
SNP B.4f P, PAwato-
Print Name Print Name
Sft-J~wZ 455mr4rC y I s- if t-3
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. C
APP ED Azgl1L
_..I~ i3
Date , .
D:\My Documents\Work\Pursuits\Ashland\DEA Contract 20130408.docx
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
i Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
i
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:
K (1) 1 carry out the labor or services at a location separate from my residence or is in a
P specific portion of my residence, set aside as the location of the business.
i
t (2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
i
X (3) Telephone listing is used for the business separate from the personal residence listing.
K (4) Labor or services are performed only pursuant to written contracts..-.',,
I ~C (5) Labor or services are performed for two or more different persons within a period of one
year. ~~•.~t.
P
K (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 sa. 6~r `~/Sl2a~s
v
t C ntractor (Date)
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D:\My Documents\Work\Pursuits\Ashland\DEA Contract 20130408.docx
D D
0
DAVID EVANS
ANDASSOCIATES INC.
Scope of Work
City of Ashland
Mt. Ashland Summer Work Plan
Task 1- Summer Plan Review
DEA will review the summer work plan documents provided by the City of Ashland. Review will focus on
the potential effect of construction activities on the watershed (erosion and sediment control). DEA will
provide the City of Ashland with a memo summarizing findings from the work plan
Task 2 -Summer Plan Budget Review
DEA will review the proposed budget for the work plan. Using information provided, DEA will compare
the budget with the proposed work and look for any items that are overlooked. DEA will prepare a
memo reviewing the proposed budget.
Task 3 - Site Observation
DEA will provide limited on site observation. The site observation will be focused on level of care that is
being given to protection of the watershed. DEA will be available as required during construction and
will coordinate site visits with the City of Ashland. DEA will provide pictures and daily field notes for
days that DEA is on site.
320 Southwest Upper Terrace Drive Suite 101 Bend Oregon 97702 Telephone: 541.389.7614 Facsimile: 541.389.7623
• ~
A417CWl ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODIYWV)
12/12013 4/23/2013
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 endorsement(s).
PRODUCER Locklon Companies, LLC-I Kansas City CONTACT
NAME
444 W. 47th Street, Suite 900 E. EoD AG No:
Kansas City MO 64112-1906 EIAAIL
(816) 960-9000 ADDRESS:
INSURERS AFFORDING COVERAGE NAICs
INSURER A: Zurich American Insurance Company 16535
INSURED DAVID EVANS AND ASSOCIATES, INC. INSURER e: 1 exington Insurance Company 4
1331235 2100 SW RIVER PARKWAY INSURER C:
PORTLAND OR 97201 INSURER 0:
NSURER E:
INSURER F
COVERAGES DEAIN01 CERTIFICATE NUMBER: 12314781 REVISION NUMBER: XXXXXXX
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. .
INSR rypE OF INSURANCE ADO SUER POLICY EFF POLICY EXP LIMITS
LTR NSR MD POLICY NUMBER IMMIDDIYYY~ MMIDD/YYYY
A GENERAL LIABILITY Y N GLG 9830389 12/1/2012 12/1/2013 EACH OCCURRENCE S %1 000000
X MMERCIAL GENE ILITV . DAMAGE RENTED
PREMISES ( (Ea occurrence) E $300,000
CLAIMS-MADE X OCCUR MED EXP An one arson E
PERSONAL S ADV INJURY $ $1,000,000
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG E
POLICY PRO- LOC $
JECT
A AUTOMOBILE LIABILITY Y N BAP 9830390 12/1/2012 12/12013 ~Vhlblrlttj WIN UE LIMIT
(Ea accident) $
J{ ANY AUTO BODILY INJURY (Per person) $ 3(X ~(XXX
ALL OWNED SCHEDULED BODILY INJURY Per ecddent E
AUTOS AUTOS PROPERN DAMAGE $ XXXXXXX xxxxxxx
X HIRED AUTOS X AUTOS""'
$XXXXXXX
UMBRELLA LV1B OCCUR NOT APPLICABLE EACH OCCURRENCE $ xxxxXXX
EXCESS DAB CLAIMS-MADE AGGREGATE E XXXXXX
DED RETENTIONS $ xxxxxxx
A WORKERS COMPENSATION YIN N WC 9336626 12/1/2012 12/12013 TORY LIMIT ER
AND EMPLOYERS' LIABILITY
ANY PROPRIETORPARTNERIEXECUPVE NIA E.L. EACH ACCIDENT
ndafte MEn NH ) EXCLUDED? $500 000
FFICE I $
OF I NH E.L. DISEASE - EA EMPLOYE $
If yes, descnbe under
DESCRIPTION OF OPERATIONS W. E.L. DISEASE - POLICY LIMIT $ SLIM
11 PROFESSIONAL N N 013001600 1/112013 12/12013 PER CLAIM $1,000,000
LIABILITY ANNUAL AGGREGATE $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES,(AUach ACORD 101, Addi tonal Remarks Schedule, If morespan H required)
ASHL0000-005 CITY OF ASHLAND PLAN REVIEW. THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND
EMPLOYEES ARE ADDITIONAL INSURED WITH RESPECT TO GENERAL AND AUTO LIABILITY, THESE COVERAGES ARE PRIMARY AS
REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED'S COVERAGE IS EXCESS AND NON-CONTRIBUTORY ON THE GENERAL LIABILITY,
AND ON THE AUTO LIABILITY AS RESPECTS TO USE OF VE141CLES OWNED BY DAVID EVANS AND ASSOCIATES, INC.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12314781 AUTHORIZED REPRESENTATIVE
CITY OF ASHLAND
ATTN: BETSY HARSHMAN, ADMIN. SUPERVISOR
20 EAST MAIN STREET
ASHLAND OR 97520
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 01988-2010 ApOffl) CORPORATION. All rights reserved
CITY RECORDER Page 1 / 1
CITY OF
DATE PO NUMBER'.
ASHLAND
200 EMAIN ST. 4/22/2013 1,1556
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 003353 SHIP TO: Ashland Public Works
DAVID EVANS AND ASSOCIATES, CORPORATE ( (541) 488-5587
2100 SW RIVER PARKWAY 51 WINBURN WAY
PORTLAND, OR 97201 ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net Dept.: '
Req. Del. Date: - Contact: Mike Fauqht
Special Inst: Confirming? No
Quanfi Unit - Description Unit Price' Ext. Price,
Plan review and construction inpsection 10,000.00
on an as needed basis. Not to exceed
$10.000
Contract for Personal Services
Beqinninq date: 04/02/2013
Completion date: 04102/2014
SUBTOTAL 10 000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 10,000.00
ASHLAND, OR 97520
'Account Number; ..Project Number Amount' Account Number Project Number . 'Amount:
E 670.08.15.00.60410 E 201307.100 10 000.00
Auth zed Signature VENDOR COPY
FORM#3 CITY of
A request for a Purchase Order 7~S H LAN D
REQUISITION Date of request: 4/11/2013
Required date for delivery: ASAP
Vendor Name rlavirf Fvang and A-snnintpq
Address, City, State, zip 2100 SW River Parkway Portland OR 97201
Contact Name & Telephone Number Jon Burgl Senior Associate / 541-749-1457
Email Address jpbu@deainc.com
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emernencv
❑ 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 #
❑ VerbalNVrilten quote(s) or proposal(s) ❑ State 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 Dale original contract approved by Council:
❑ (3) Written proposals attached Date approved by Council: (Date)
❑ Form #4, Personal Services $51K to $75K Valid until: Dale
Description of SERVICES Total Cost
Plan review and construction inspection on an as-needed basis. Not to exceed $ 1000.00
$10,000.
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COiST
❑ Per attached quotelproposal $
Project Number 2013.07 Account Number 670.08.15.00.604100
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.
'mow (d~~_ 4 1s-113
Employee Signature: ~ Department Head Signature: uanGt,-~
L7 (Equal to or greater than 06)
City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year., Es / NO 0; 117G a- 4 ~
Finance Director- (Equal too aterthan $5,000) Date
Comments:
Form #3 - Requisition