HomeMy WebLinkAbout2013-184 Contract - Weldons Enterprises
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Weldons Enterprises, Inc.
ASHLAND CONTACT: Steve Weldon
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 4008, Medford, OR 97501
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-772-7973
DATE AGREEMENT PREPARED: 07/17/2013 FAX: 541-857-2077
BEGINNING DATE: Jul 1, 2013 COMPLETION DATE: June 30, 2014
COMPENSATION: Prices for cleaning and pressing uniform clothing items are included in the proposal
attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Uniform Laundry Services to be provided as required in the
ITB attached as Exhibit D.
ADDITIONAL TERMS: This.contract may be extended for an additional year for a maximum term of two (2)
ears.
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, 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 $19,825 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:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 1 of 5
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.
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 insurers to
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 2 of 5
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.
Contra ccity of Ashland
By By t'
Signature Departm nt Head
S71eve l/l eVo,,7 f r k e Ic e u
Print.4me Print Name
Title ID~e' 1 l
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. /
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, 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:
-g~'-V(1) I 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.
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 4 of 5
WELDON'S ENTERPRISES, INC.
P. 0. BOX 4008
MEDFORD OREGON 97501
541-772.7973/FAX 541-857.2077
May 29, 2013
Official bid proposal for laundry services for the City of Ashland
This bid proposal is for the period from July 1, 2013 to June 30, 2014.
Shirts (men's button up the front, cotton/cotton blend) $3.00
Shirts (pullovers) $5.00
Pants $5.00
Sweatshirts (any pullover type with/without buttons at neck) $5.00
Jackets $5.00
These prices will remain in effect for the period stated above. Itemized pickup statements will
be provided if requested: Itemized billing statements along with invoices are provided the first
of every month. Pickup and delivery is on Mondays and Thursdays.
Weldon's Enterprises, Inc. agrees to provide these services from July,12013 to June 30, 2014
and provide insurance certificates for general liability, automobile and Workers' Compensation,
including the City of Ashland as the additional insured.
Steve Weldon Date
°
FORM #2 C I T Y OF
ASHLAND
INVITATION TO BID
INTERMEDIATE PROCUREMENT
Release date: May 24, 2013
Requested by: Kariann Olson, Purchasing Representative
Tel: 541488-5354 Fax: 541488-5320
Kari.olson@ashland.or.us
Bids are due prior to: 2:00 PM, Thursday, June 6, 2013
Project name: UNIFORM LAUNDRY SERVICES
Pickup/Delivery location: Electric Department, 90 N. Mountain, Ashland, OR 97520
Bids may be faxed, emailed or hand delivered. Contractors shall submit bid on their company letterhead. Informal email
bids and/or late bids will not be accepted. Terms or discounts which are conditioned upon payment within a certain time
will not be considered for purposes of comparison of bids. The successful contractor will be required to enter into a contract
with the City for the services and provide insurance certificates in their own name for General Liability, Automobile and
Workers' Compensation. Subcontracting will not be permitted.
SCOPE OF SERVICES
The Electric Department is requesting proposals for laundry services for employee uniforms and firm prices for
these services to be guaranteed from July 1, 2013 to June 30, 2014. This contract may be extended for an
additional year for a maximum term of two years.
Uniforms (shirts, pants, sweatshirts and jackets) for approximately 14 employees are to be professionally cleaned
and pressed as needed in accordance with the American Society for Testing and Materials (ASTM), Standard
Guide Designation: F1449-08.
Laundry services will require biweekly pickup and delivery checked in and out with a City staff member
accompanied by itemized pickun and billing statements.
Please provide an official orooosal on your company letterhead, including the following information:
1. Firm prices for cleaning and pressing each of the following items in accordance with ASTM
standards:
a. Shirts
b. Pants
c. Sweatshirts
d. Jackets
2. Requirements or limitations for identifying individual pieces of clothes
3. Written confirmation that itemized pickup and billing statements will be provided and prices will be
guaranteed until what date (June 30, 2014)
4. Proposed pickup and delivery schedule (Note: Any changes to the actual schedule will need to be
agreed to by both parties)
5. Written confirmation that you are willing to enter into a contract to provide these services from July
1, 2013 to June 30, 2014 and provide insurance certificates for general liability, automobile and
Workers' Compensation, including the City of Ashland as the additional insured.
Due date and time for submitting quotes is 2:00 PM, Thursday. June 6, 2013. Late quotes will not be considered.
If you have any ouestions and/or need additional information, please contact Kariann at 541-488-5354.
Thank you.
Method of Award: ORS 279B.070 Intermediate Procurements. (4) If a contract is awarded, the contracting agency shall award the
contract to the offeror whose quote or proposal will best serve the interests ofthe contracting agency, taking into accountprice as well
as considerations including, but not limited to, experience, expertise, product functionality, suitabi/ityfor a particular purpose and
contractor responsibility under ORS 279B. 110.
Form #2 - Intermediate Procurement, Invitation to Bid, Trade Services, Page I of 1, 5/24/2013
AI ~ ~ TNIS ENDORSG1(T NAA GES THE POLICY. PLEASE READ IT CAREFULLY. E4277
J
' E4277
Policy Number: 60465-61-42 1st Edition
POLICY CHANGES
Effective Date of Change: 07/19/13 Expiration Date: 06/12/14
Change Endorsement No.: 002 Agent: 73-01-322
Named Insured: WELDON'S ENTERPRISES INC
PO BOX 4008
MEDFORD OR 97501-0144
The following item (s):
Insured's Name Insured's Mailing Address
Policy Number Company
Effective / Expiration Date Insured's Legal Status / Business of Insured
Payment Plan Premium Determination
X Additional Interested Parties Coverage Forms and Endorsements
Limits / Exposures Deductibles
Covered Property / Location Description Classification / Class Codes
Rates Underlying Insurance
is (are) changed to read {See Additional Page(s)):
-7
The above amendments result in a change in the premium as follows:
X No Changes To Be Adjusted At Audit Additional Premium Return Premium
Authorized Representative Signature:
i
i
FARMERS
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E4777{01
Polity Changes Endorsement Description
ADD ADDITIONAL INTEREST
ADDITIONAL INSURED - CA20480299
ADDITIONAL INSURED-DESIGNATED INSURED
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
2003 FORD ECONOLINE
VIN: IFTRE14263HB28923
2005 CHEVROLET EXPRESS G 1
VIN: IGCFG15X251154213
Removal If Covered Property is removed to a new location that is described on this Policy Change,
Permit you may extend this insurance to include that Covered Property at each location during
the removal. Coverage at each location will apply in the proportion that the value at each
location bears to the value of all Covered Property being removed. This permit applies up
to 10 days after the effective date of this Policy Change: after that, this insurance does not
apply at the previous location.
914777 ISI EOI110N 742 In&gdn (Word lWariA IMM Sew= ON'n, bc, mob is pnffbSm E4277102 PAGE 2 OF 2
E0277F01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY.
E4277
Policy Number: 60465-61-42, _ 1st Edition
POLICY CHANGES
Effective Date of Change: 07/19/13 Expiration Date: 06/12/14
Change Endorsement No.: 002 Agent: 73-01-322
Named Insured: WELDON'S ENTERPRISES INC
PO BOX 4008
MEDFORD OR 97501-0144
The following item (s):
Insured's Name Insured's Mailing Address
Policy Number Company
Effective / Expiration Date Insured's Legal Status / Business of Insured
Payment Plan Premium Determination
X Additional Interested Parties Coverage Forms and Endorsements
Limits / Exposures Deductibles
Covered Property / Location Description Classification / Class Codes
Rates Underlying Insurance
is (are) changed to read {See Additional Page(s)):
The above amendments result in a change in the premium as follows:
No Changes To Be Adjusted At Audit Additional Premium Return Premium
Authorized Representative Signature:
FARMERS
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[1277{01
Polity Changes Endorsement Description
2001 CHEVROLET ASIRO VAN
VIN: 1 G CDL 19W01 B 102393
Removal If Covered Property is removed to a new location that is described on this Policy Change,
Permit you may extend this insurance to include that Covered Property at each location during
the removal. Coverage at each location will apply in the proportion that the value at each
location bears to the value of all Covered Property being removed. This permit applies up
to 10 days after the effective date of this Policy Change: after that, this insurance does not
apply at the previous location.
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EI277{Ol
BUSINESS AUTO
DECLARATIONS TRUCK INSURANCE EXCHANGE '
D POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES
❑ COVERAGE PART NOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010
REM ONE
NAMED WELDON' S ENTERPRISES INC Account 85 9
-
Number Rod. Count
INSURED
MAILING PO BOX 4008 73-01-322 60465-61-42
ADDRESS gem olry umT f~A~ erg
MEDFORD OR 97501-0144
Type of
The named insured is an individual ❑ Partnership ❑ Corp. Business
unless otherwise stated: ❑ Joint Venture ❑ Organization (Other than Partnership or joint venture)
Policy Period from 07/19/13 (not prior to time applied for) to 06/12/14 12:01 AM Standard Time
If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not
take effect until the other coverage ends. This polity will continue for successive policy periods as follows: If we elect to
continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period
subject to our premiums, rules and forms then in effect.
REM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS
*This policy provides only those coverages where a char~e is shown in the premium column below. Fach of these coverages
will apply only to those "autos" shown as covered "autos . "Autos" are shown as covered "autos" for a particular coverage by
the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to
the name of the coverage.
*COVERED AUTOS LIMIT
THE MOST WE WILL PAY FOR
COVERAGES ANY ONE ACCIDENT OR LOSS PREMIUM
LIMITS SHOWN IN THOUSANDS
LIABILITY 7 S 300 1,173.00
PERSONAL INJURY PROTECFION 7 SEPARATELY STATED IN EACH PIP ENDORSEMENT 72.00
(or equivalent No•FaunN Coverage)
ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED PIP ENDORSEMENT
(or equivalent added no-fault (ov.)
PROPERTY PROTECTION INSURANCE SEPARATELY STATED IN THE P.P.I. ENDORSEMENT MINUS
(Michigan only) $ DEDUCTIBLE FOR EACH ACCIDENT
AUTO MEDICAL PAYMENTS 7 $'SEE SCHEDULE
UNINSURED MOTORIST 7' $ SEE SCHEDULE 147.00
UNINSURED MOTORIST $
PROPERTY DAMAGE
UNDERINSURED MOTORISTS (When not 7 S
incl. in Uninsured Motorists (overage)
Actua Cas Va ue or Cost o Repair, whichever is
PHYSICAL DAMAGE less minus $ SEE SCHEDULE Ded. for EEqch Covered
COMPREHENSIVE COVERAGE 7 Au o. But no Deduct
ible Its to Loss Caused by Fire or 199.00
Li itnin . See Item Four for hired or borrowed autos'.
PHYSICAL DAMAGE SPECIFIED Attu Cash Va ue o Cost o e air, is ev r i
CAUSES OF LOSS COVERAGE 7 LCesps Iqus A$12 Ded. fpJ Eqcndaism. [m. Qre SeeItem Auto or ourT~psor shired
prVa
or bo rLy 0A
Was
PHYSICAL DAMAGE Actual Cash Value or Cost of Repair whichever is
COLLISION COVERAGE 7 less minus S SEE SCHEDULE De4. for Each Covered 327.00
Auto. See item four for hired or borrows 'Autos'.
TOWING AND LABOR 7 $ soo (auto' (ACTUAL LIMIT] covered 57.00
PREMIUM FOR ENDORSEMENTS
ESTIMATED TOTAL PREMIUM 1,975.00
FARMERS
S6-5190 6tH EDMON 310 C5190601 PAGE 1 OF 3
565190{06
60465-61-42
II Hooker.-
BUSINESS AUTO DECLARATIONS (Cootmoed)
ITEM THREE
SCHEDULE OF COVERED AUTOS YOU OWN
DESCRIPTION TERRITORY
PURCHASED
YPq', f~ode~ Tr do oats, Bgdy Typ@. Town & SlJate where (overed
A~or~ Serial um or S) I~e ~cj entl cotton (lumber Oor ipeW Act of l l t' Auto will he principally garaged
A 03 FORD CARGO A ECONOLINE 22420 MEDFORD OR 203
1FTRE14263HB28923
3 05 Ct1HytEEVRyOgOpLE~,L19Ii0ET2q5115421CARGO VAN EXPRESS G1 22810 MEDFORD OR 203
4 01 1GCD1B10239gg3XTENDED C ASTRO VAN 22993 MEDFORD OR 203
CLASSIFICATION
a lus o Business use Size Age rlmary con ary o e Except for towing, all physical damage
Aeration s - serv i e . GON or Veh. Group acing acing loss is payable to you and the loss
r -retail katiog odor dor payee named below as interests
~ofor~ad c -commercial (opacity Ia ci i may appear at the time of the loss. so --EF-
3 50 10000 9
4 S0 10000 D BLE5 sense o a udI or limit entry in any column below means that the Imrt or udI entry
in the
comes on in ITEM TWb co umn applies instead
LIABILITY PERSONAL INJURY PROTECTION ADDED P.I.P. emFt PROP. PROT. III Mt on
*Limit remium II nd mine ad Premium ImADStgtQ i~nd.c end mlotu ud. Premium
Covert~ dd d P I.
300 Auto No. &A a shown minus remium shown ~elow
-T 39100 0 Z4uo 300 391.00 0 24.00
4 300 391.00 0 24.00
ota
Premium 1,173.001
72.00
Bence o a deductible or limit entry in any column below means that the Imrt or udI entry In t e
corres ondin ITEM * column applies instead)
Covered AUTO MED. PAT UNINSURED ORISTS UNINSURED MOTORIST UNDERINSURED MMIUSTS
PROPERTY DAMAGE
Auto No. *Imrt remium * Imrt Premium Imrt Premium 1imit Premium
00 49.0 300 INC UD EDW
4 00 49.0 300 INCLUDED
ota
Premium 147.0 LIIBR~ sense o a deductible or Imd entry 1n any Column below means t at t e Imd or udI entry In t e
corres ondin ITEM TNfO column applies instead
CUIRPRIU11toolvit SPECIFIED CAUSES OF LOSS COLLISION TOWING LAIOR
t I Premium der Premium
Opted Premium Limit st n ITEM ITW TWIN
Auto e 21, s~IOwn be w Pre bum s I~ormjebwd. Disa~ement 00 3 500 103.00 1000 69.00 500 19.00
4 500 19.00
Ot0
Premium 199.00 327.00 57.00
'(LIMBS SHOWN IN THOUSANDS)
565190 61H EDITION 3-10 (5190601 RAGE 10F 3
565190406
60465-61-42 "
Policy No er
USINESSAUTO DECLARATIONS (CONTINUED)
`
`
EM FOUR
SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS
LIABILITY COVERAGE RATING BASIS COST OF HIRE
STATE ESTIMATED COST OF HIRE RATE PER EACH 100 FACTOR(( Nab. PREMIUM
FOR EACH STATE COST OF HIR COV. IS PRIMAR
PREMIUM
Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent
from your employees or their family members). Cost of hire does not include charges for services performed by motor carriers
of property or passengers.
PHYSICAL DAMAGE COVERAGE
LIMB OF INSURANCE ESTIMATED RATES PER
COVERAGES THE MOST WE WILL PAY ANNUAL EACH $100
DEDUCTIBLE COST OF HIRE COST OF HIRE
ACTUAL LASH VALUE COST OF REPAIRS ON
S WHICHEVER IS LESS MINUS
COMPREHENSIVE
S DED. FOR EACH COVERED AUTO.
BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY
FIRE OR LIGHTNING.
ACTUAL CASH VALUE, COST OF REPAIRS OR
SPECIFIED S WHICHEVER IS LESS MINUS
CAUSES OF LOSS S25 DED. FOR EACH COVERED AUTO FOR LOSS CAUSED
BY MISCHIEF OR VANDALISM. ACTUAL CASH VALUE, 19TUMUS OR
COLLISION S WHICHEVER IS LESS MINUS
S DED. FOR EACH COVERED AUTO
PREMIUM
ITEM FIVE
SCHEDULE FOR MON•OWNERSHIP LIABILITY
NAMED INSUREDS BUSINESS RATING BASIS NUMBER PREMIUM
Other than a Number of Employees
Social Service Agency Number of Partners
Social Service Agency Number of Em to ees
Number o Vo unteers
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY,
WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
Premium shown is payable: $ 1,975.00 at inception.
ENDORSEMENTS ATTACHED TO THIS POLICY: IT, 00 21-Broad form Nuclear Exclusion (Not applicable in New York)
CA00010310 CA00381202 CA20480299 CA21050110 CA21870110 CA22360110 CA23860106
IL00210498 IL02790702 J6738-ED1 57338-ED1 S7340--EUF 25-2614E04 56-5166ED5
LOSS PAYEE
4
COUNTERSIGNED BY
(Date) Authorized Representative
565190 61H FDIPON 3-10 [5190601 PAGE 3 OF 3
5651901D6
POLICY NUMBER: 60466-61-42
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured
Provision of the Coverage Form. This a ndorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is
indicated below.
Endorsement Effective: Countersigned By:
07/19/13
Named Insured:
WELDON'S ENTERPRISES INC Authorized Representative)
SCHEDULE
Name of Person(s) or organization(s):
CITY OF ASHLAND
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent
that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained
in Section II of the Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
7/19/2013 9:d6 AM FROM: HJGerha[d-Farmers TO: 541-49S-5320 PAGE: 002 OF 002
CERTIFICATE OF LIABILITY INSURANCE o;;,,n~° 0 73
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: B the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the /firms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not corder fights to the
certificate holder in lieu of such Endorsement(s)-
PRODUCER Harry J. Gemara
Harry Gerhard(7301322) m,NIP,E4; r'"1...1 -864-8215 541-665-3523
650 E Pine St Ste 102a auoneSS, noerhemfG~lannersaoeDLtAJD
(INSURERS) AFFORDING COVERAGE MACa
Central Point OR 97502-2482 INSUMRA: Truck Insurance Exchange 21709
INSUREO INSURERB: Farmers, Insurance Exchange 21652
WELDON'S ENTERPRISES INC INSURERS: Mid Century Insurance Company 21687
PO BOX 4008 INSURER o : _
INSURER E :
MEDFORD OR 97501 NSURERF;
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 COMI rioNs OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TAPE OF INSURANCE A U POUCYNWnern POLKY IFF POLICY EIS
R LIMITS
GENERAL WBILITV EACH OCCUflHENGE S
(EA
T011E.--yF9 QPo,,vmP*I
CWMSJ.W)E OCCUR MED EXP(Any, PNeab) 1S
PEHSONUwwOV AWRY IS
_
GENERAL AGGREGATE ! S
I :PRODUCTS ~ COMP,(? AGI3
i
GENL AGGREWT E UMIT wPPL1E5 PEW. I
POLICY PRO. LQ i i
wurOMOe11E"AmurY CO MBIrvEOFSINOLELIMn 300,000
ANYAIRO BODILY INJURY (F. xMMI15 I S
ALL OWNED SCHEDULED .....LY ....IN.......JU...
RY IPnamdnq I
A AIRES AUTOS 804658142 08/12/2013 08/12/2014 BOUI f
HIRED AUTOS AUTOS NO~WNED PROPERTY DAN WE
I,....., AUTOS P ~r n
i
UYBRELIA WB OCCUR EACH OCCURRENCE S
f1WE9.R 4AB LIAWSMADE! AGGREGATE :f
GE, RETENTIONS S
AND EMPSLOYYES LIABILITY LIAABILIWTY WC9M E:i
:AND EMP -
ANYPROPRI-TORL-NARTNEREXECUTIVB T--7 IL EL. EACH KCIDENT ii
OEFICERMEMEER EJ(CLVDEDi IfA
(WMMery In MR) .I EL. DIREw$EEA EMPLOYEES
II y~• UewDe w l
OE:LmMIOrv OF O, ERATIONS below E.L OIEEASE - POLICY UWT : s
DESCRIPTIONOFOPERATIONSILOCATIONSIVEHICLES(Al hACORD101,A44RHDel Renrhescll W,IImen"y NreWMOI
2001 CHEVROLET ASTRID VAN; VIN[ 1GCOL19'WO113702393
20(15 CHEVROLET EXPRESS G1 VAN; VIN: iGCFG15X251154213
2003 FORD ECONOLINE VAN; VIN: 1FTRE14263HB28923
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE
CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS.
AUTOO R EBENT W _ y
ASHLAND OR 97520 A
1 v l-
ACORD 25 (2010105) 9 -2010 ACORD CORPORATION. All lights rsserved.
The ACORD name and logo are registered marks of ACORD
Jul.19. 23'3 9,17AM GRANITE PROFESSIONAL INSURANCE No.1635 P. 1
WCLDO-t OP ID: RA
CERTIFICATE OF LIABILITY INSURANCE 0 °711927/19Y201J°^3
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
REPRESENTATIV! OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION 15 WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate dam not confer rights to the
certificate holder in IIeU of such endomem a .
PRODUCER Phone: 925-462-6400
Granite Prof Ins Uc COC41066 Fax: 926-462$886 reom FAX
Brokerage, Inc. N0:
8600 Koll Carter Parkway 6100 E
Pleasanton, CA 94666
Rachel Anders INSUR 6 APPORDNO OOvEmde NM00
NsuRER A: Employers Preferred Ins Co
NPAWD Weldon's Enterprises Inc INSURERS,
711 West Stewart Ave NsuRERC:
Medford, OR 97801
INSURERO:
NsurlaRe:
awuaERC:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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.
PHIR AID SUB
TYPE OF INSURANCE
IMR POLILYNUHBER M UNITS
GENERAL LIAeILRY eACM OCCURRENCE S
COMERCLAL GENERAL LIABILITY PREMISESG occtinam f
0.NMSMAOE F7 OCCUR MED EXP (Any . .Pn f
I PERSONAL aAW INJURY
GENERAL AGGREGATE S
_ OENLAOOREOATE LIMIT APPLIES PER PRODUCTS-GOMPIOP AGO I
POLICY I PRO- LOC
/
AUTOHONLE UAS&MY - l0A8.*1,ED SINGLE UNIT
ANYAUTO BODILY IWURY(Per pwN ) S
♦u OWNED TOS teD
'AUTOS AUTOS BODILY N/URYIPrr a0dln0 1
HIRED AUTOS NO oO NED 7ROPTff7 AALA f
AUS
I a
UIIBRELU LNe occuR ( EunoccuRRENCe a
Elf^.ESa1 CIAORB-MADE AGOREGATE /
DED RETENTION Is
WORXERe00arENSAVON X -
UEA~L YJN
ANDENMOYERa'llAelnY
A AWPAWRIETOPUP
pARTNO )MCUITM NIA EIG12'IB716D6 06fiNY10fT 06101J2D1d ELEACHACCIOENT 1 600,0
(NSnd.t., in NN) EL DISEASE EA ENPLOYE f 60010
R aPPe. 101
D SCRIPTI NDP ERATI NSO/INN C.L. DISEASE •POLICY lWR f 600,000
I
i
OCSCRIPrIpr a OPEMTIRA / LOCI1nDN61 VEHgLp6 UR.m Ae011D 101, gd0lUPnd RunNlru 6dNdW., Ilmw. men I. nq,lnlq
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CI Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHON= REPRESENTATIVE
0IM-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo am registered marks Gf ACORD
07/22/2013 13:53 FAX 541 7763299 RUSS WIMMER STATE FARM IQJ 001/001
Ago CERTIFICATE OF LIABILITY I RANCE 07ii2/20D 3"
THIS CERTIFICATION IS I LIED AS A MATTER OF INFORMATION
PaooucER
Russ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bamer State Farm
2936 E Barnett Rd Suite 101 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
O Medford, OR 97504
INSURERS AFFORDING COVERAGE NAIC S
INSURED INSURER A: St.b Falco I" and C~ualry CII D p 7514E 25143
Weldon Enterprises Inc- INSURER B:
PO BOX 4009 INSURER c:_
Medford, OR 97501 INSURER D:
INSURER E:
COVERAGES
NDING
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICfi
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE R
EREIN IS SUBJECT YO All THE TERMS, EXCLUSIONS ANSUCH
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H
POLICIES. AGGREGATE LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. v..
POLICY EFFECTIVE LICY EPIRATION Try LIR Aff An TYE OP INSURANCE POLIL7 NUMBER DAMM'DDn DATE MwDDIYYTY
INS
X GENERALLIABRRY 97.80-H307-8 F 06107(1013 0810112014 EACH OCCURRENCE 00.000
PTEO COMMERCIAL GENERAL UABIUTY S MCLAIMS MADE X OCCUR MED E)(P (AM one PenSAW
PERSONALSA0 INJGENERAL AGGREGAT00,000
PRODUCTS-COMPfOPA00 E 2,000.000
GENT AGGREGATE LIMIT APPLIES PER.
E
X POLICY PRO-
JECT LOG
AUTOMOBILE UABNTY COMBINED SINGLE UNIT E
(Ea aWAerM1I
ANY AUTO
ALL OWNED AUTOS BODILY INJURY E
(Par FNean)
SCHEDULED AUT05
HIRED AUTOS BODILYINJURY S
_ . (Fbr eWLenU
NON-0MED AUTOS
PROPERTY DAMAGE S
(PeraWdael)
AUTO ONLY - EA ACCIDENT E
GARAGE LIABILITY - G ADC E
ANY AUTO OTMERTHAN
gUTOONLY: qOG E
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR ❑CLAIMS MADE AGGREGATE
5
5
DEDUCTIBLE -
E
RETENTION f
WORKERS COMPENSATION AND -IT Ry LIMBS _ t7i
EMPLOYERS' LIBILITY E.L. EACH ACCIDENT E
ANY PROPRIETOR/PARTNERIEAECU IVE T-
OFFICEIVMEMSER EXCLUDER/ E.L. DISEASE - FA EMPLOY E
IMaaCAmrY In NH1 E.L DLSEASE-POLICY LIMB S
R yae, GaacdAe antler
OTHER
DESCRIPTION OF OPERATONSI LOCATIONS I V EHU:LIS I BXCLUSION6 ADDED 8T ENOORSEMENTI SPECIAL PROVISIONS
DRY CLEANING 8 LAUNDRYSERVICES
1465 SISKIYOU BLVD
ASHLAND, OR 97520
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OFASHLAND ELECTRIC DEPT ATTN:KARIOLSON DATE THEREOF. TXEISSUINGINSURER WILL ENDEAVOR TOMAIL 3Q_ "vSYAUTrER
90 N MOUNTAIN AVE NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAADRE TO 00 SO SHALL
ASHLAND, OR 97520 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AYTHOROED REPPEBENTATNE
I
ACORD 25 (2009101) ®1888-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD 1001486 132849.3 04-06-2009
c CITY RECORDER Page 1/ 1
CITY OF
ASHLAND DATE PO NUMBER
20 E MAIN ST. 7/30/2013. 11758
ASHLAND, OR 97520
(541)488-5300
VENDOR: 013103 SHIP TO: Ashland Electric Department
WELDON'S ENTERPRISES, INC, WELDON'S CLE/ (541) 488-5354
PO BOX 4008 90 N MOUNTAIN
MEDFORD, OR 97501 ASHLAND, OR 97520
FOB Point: - Req. No.:
Terms: Net Dept.: -
Req. Del. Date: Contact: Marv MCClarv
Special Inst: Confirming? NO
Quantity Unit' Description - Unit Price Ext. Price
Uniform Laundry Services FY 2014 6,500.00
Contract for Goods and Services
Beginninq date: July 1, 2013
Completion date: June 30, 2013
SUBTOTAL 6 500,00
BILL TO: Account Payable TA 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 6,500.00
ASHLAND, OR 97520
Account Number Project Number ' Amount Account Number 'Project Number Amount
E 690.11.18.00.60135 6,500.00
Authorized Signature VENDOR COPY
FORM #3 CITY OF
ASHLAND
REQUISITION Date of request:
Required date for delivery:
Vendor Name WELDONS ENTERPRISES, INC.
Address, City, State, Zip PO BOX 4008, MEDFORD, OR 97501
Contact Name & Telephone Number STEVE WELDON 541 77 .7 7
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 f le) ❑ State of Oregon
❑ Direct Award Date approved by Council: Contract #
❑ VerbaliWritten 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 and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
Intergovernmental Agreement
PERSONAL SERVICES El Special Procurement ❑ Agenc
$5.000 to $75,000 El Form #9, Request for Approval y
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposals/written solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
Uniform Laundry Services for FY 2014 (July 1, 2013 to June 30, 2014) Not to exceed $6,500.00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quotelproposal
Not to exceed Not
Project Number Account Number 690.11,13.00.601350 to exceed $6,500.00
'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 softyrars purchases:
ITDireefor Date Support •Yes'/No
B signing this requisition form, I certify that the City's public contracting requirements he been satisfie .
Employee Signature: C Department Head Signature: MA k
(Equal to or greatenn n 5,000)
City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for currant fiscal year YES / NO
Flnanc2 Director- (Equallo or.ymter th)n $6,000) Date
Comments:
Form #3-Requisition