HomeMy WebLinkAbout2013-143 Contract - Green Valley Pump
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Green Valley Pump
ASHLAND CONTACT: John Love, iohnCa2greenvallevoumg.com
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 609 S. Pacific Hwy, Talent, OR 97540
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-535-4275
DATE AGREEMENT PREPARED: June 4, 2013 FAX: 541-535-3984
BEGINNING DATE: June 5, 2013 COMPLETION DATE: June 21, 2013
COMPENSATION: Not to exceed $4,000.00
GOODS AND SERVICES TO BE PROVIDED: Emergency repairs to Lithia Springs pump located at Ashland
Gun Club. Estimate #604, $1,125.79 is to remove and replace motor. If pump is found to be inoperable, it will
need to be removed and replaced with a new pump for an additional cost. The initial estimate to repair motor
is 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 2796.220, 2796.225, 2796.230, 2796.235, 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. Citv'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.
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 2 of 5
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. 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 may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contr cCity of Ashland
By By \ \ Q
Signature Department Head
~n V_~ o tr~~ tM~_c4 rkf l 2_ F;,urPld-
Pr t Name Print Name
~I~SL~ ~F~N~2~3 ;(p IS/r3
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. G (O
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:
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.
t- (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.
S L (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.
~ aI
Contra or (Date)
Contract for Goods and Services Less than $25,000, Revised 06/3012012, Page 4 of 5
°r? Green Valley Pump Inc. ESTIMATE
~J 609 South pacific Hwy
Talent Or. 97540
CCB # 97283 phone # 541535-4275 Date 6/3/2013
WTI 413 Fax # 541535-3984
johnDgreenvalleypump.com
steve0greenvalleypump.com Estimate # 604
City of Ashland
20 E Main St
Ashland, OR 97520 Lithia Water-
Job Site: pump at gun club
Customer E-mail gate code 3840 Customer Phone 488-5353
Description - Qty
Gun Club/ Lithia water Well pump has quit working.
This is an estimate for changing out the motor and installing your back up pump end.
I hp, 3 wive, 230V Motor 1
2 men with crane truck to pull pump 1.5
2 men with crane truck to set pump 2.5
2" MilSpec tape 1
Blue Monster teflon tape 1
sabot splice kit 1
This is all of the known material that we will need as of now. There may be some incidental material
needed as we open up the well head. .
The total cost will not exceed $1225.79
If Bid accepted, please sign and return:
Total $1,125,79
www.saifxom
OREGON WORKERS COMPENSATION ♦
CERTIFICATE OF INSURANCE ip,sai
corporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
20 E MAIN
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated. The insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
450836 04/01/2013 to 04/01/2014 06/03/2013
INSURED: BROKER OF RECORD:
GREEN VALLEY PUMP INC
609 S PACIFIC HWY
TALENT, OR 97540-9635
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500;000 each employee
Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate holder.
This certificate does not amend, extend or alter the coverage afforded by the policies above. This
certificate does not constitute a contract between the issuing insurer, authorized representative or
producer and the certificate holder.
AUTHORIZED REPRESENTATIVE
President and CEO
400 High Street SE
Salem, OR 97312
P:800.285.8525
F: 503.373.8020
roery_certwca:ca_certirceteonnsuance
r~ 9GREEVA OPID:TS
CERTIFICATE OF LIABILITY INSURANCE 0 DAT6/0416104N/YYYY)
03
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 endorsements .
PRODUCER
541-779-4232 CONTACT .
NAME
Hart Insurance 541-7723963 PHONE FAX
1123 Royal Ave. Alc No Er : A/c MY
Medford, OR 97604 E-MAIL
Hart Insurance Agency ADDRESS:
INSURERS AFFORDING COVERAGE NAIC#
INSURER A: American Hallmark Ins Co of TX 43494
INSURED Green Valley Pump Inc. INSURERS:
609 S. Pacific Hwy.
Talent, OR 97540 INSURER C:
INSURER D :
INSURER E
NSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
INSR ADDLSUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER IMWDD/YYYY MMRIDIYYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X 44CL465783 08120/12 08120/13 PREMISES Ee occurrence $ 100,000
CLAIMS-MADE FRIOCCUR MEDEXP(Anyone Person) S 5,000
PERSONAL B AOV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OP AGG $ 2,000,000
POLICY P"0. LOC $
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT En .denl 11000,00
a
A X ANY AUTO 44CL465783 08120/12 08/20113 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per ecadent) $
AUTOS NAUTOS
ON OWNED PROPER -4?MAGE $
HIRED AUTOS AUTOS Pe,accitlent
$
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTIONS $
WORKERS COMPENSATION OR I MIT DEER
AND EMPLOYERS' LIABILITY YIN T R
PARTNERIEXECUTIVE ❑ NIA E.L. EACH ACCIDENT $
OFFICER/MEMBER ANY PROPRIETORr EXCLUDED?
(Mandatory in NH) E. L. DISEASE - EA EMPLOY $
It yes, describe under
DESCRIPTION OF OPERATIONS below E. L. DISEASE-POLICY LIMIT $ T I DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Adaeb ACORD 101, Addlllonal Rrmarke Sch.EUle, If
mon spadr Ir,equl,edl
City of Ashland is named as additional insured per MP9767 10/10
CERTIFICATE HOLDER CANCELLATION
CITYASH
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.
Public Works Dept. REPRESENTATNE
20 E. Main Street Hart Insurance rance Agency
Agencsu
Ashland, OR 97520 Hart
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
CITY RECORDER Page 111
CITY OF
ASHLAND DATE PO NUMBER,
20 E MAIN ST. - 6/6/2013 11623
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 001322 SHIP TO: Ashland Water Department
GREEN VALLEY PUMP (541) 488-5354
609 S PACIFIC HWY 90 N MOUNTAIN
TALENT, OR 97540 ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Steve Walker
Special Inst: Confirming? No
:Quanti Unit Description Unit Price : Ext. Price
Remove and replace pump motor and 4,000.00
possibly pump at Lithia Springs
wellhead located at Ashland Gun Club
Estimate #604 $1,125.79 to remove and
replace motor. If pump is found to be
inoperable, it will need to be removed
and replaced with a new pump for an
additional cost. Total services not to
exceed $4,000.00
Contract for Goods & Services
Beginning date: June 5, 2013
Completion date: June 21, 2013
SUBTOTAL 4,000.00
31LL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 4,000.00
ASHLAND, OR 97520
umtier Amount Account . Number ~:Project Number. -',Amount
" 'Account Number Project Number':'-
E 670.08.18.00.60240 4,000.00
Authorized Signature `v VENDOR COPY
FORM#3 CITY OF
.A reque-si. for a Purchase Order ASHLAND
REQUISITION Date of request: 6-5-2013
Required date for delivery: ASAP
Vendor Name Grape Valley Pump
Address, City, State, Zip 609 S Pacific Hwv
Contact Name & Telephone Number 541-541-535-4275
Fax Number
541535-3984
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
[:1 Reason for exemption: ❑ Invitation to Bid (Copies on file) 1:1 Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: El Written quote or proposal attached
❑ den uote or ro sal attached
Small-Procurement Cooperative Procurement
Les an $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Direct Award Date approved by Council: Contract #
❑ Verbal/Written quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ 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, Raquest for Approval ❑ Agency
❑ Less than $35,000, by direct appointment El Written quote or proposal attached Dale original contract approved by Council:
El (3) Written proposals attached Date approved by Council (Date)
❑ Form #4, Personal Services $51K to $75K Valid until: Date
Description of SERVICES Total Cost
Remove and replace pump motor and possibly pump at Lithia Springs wellhead
$4000
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
❑ Per attached quote/proposal TOTAL COST
$4000
Project Number Account Number 670.08.18.00.602400
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:/ Department Head Signature: LL -K~
(Equal to or greater than $5,000)
City Administrator:
Funds appropriated for current fiscal year YES/NO (Equaltoorgreaterthan$2s,ooo)
Finance Director- (Equal to orgreater than $5,000) Date
Form #3 - Requisition