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HomeMy WebLinkAbout2013-284 CONT Addendum 2 - Tristar Risk Mgmt SECOND AiMENDMEN TO CONTRACT FOR WORK P"RS' COi'VIPENSATION `CPA SERVICES Citti• of Ashland ]affective March 1, 2013 This amendment is cffective March 1. 2013 between City of Ashland and Tristar Risk Management, to amend the contract effective March 1. 2011 bern"een the fxvo parties. TERM- Per request of the City of Ashland, the term of the Contract is extended to provide services Tram March 1; 2013 to February 23, 2014. Fees- Per the terms of the original,contract, the Pees for claim administration are increased by 3.5% to 51,017.66 for Indmnnity claims and S160.68 for medical only claims. All other fees remain the same. AGREED: CONSULTANT: CPCY OFASIILAND TRISTAR RISK 41ANAG1'si~ll%NT By: - 13v: G~o~ tr" v,_-\ "L.f-~,• ~ttNE41E~G _ Thomas.L.Veallt Print name President ~fi~kAcE U~~~Eeusiz -Title Page 1 / 1 CITY OF ASHLAND DATE PO NUMBER 20 E MAIN ST. 8/9/2013 11803 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 015885 SHIP TO: City of Ashland TRISTAR RISK MANAGEMENT, CITIZENS BUSINE (541) 488-6002 TRIM ITF CITY OF ASHLAND 20 E MAIN STREET 970 W. 190TH ASHLAND, OR 97520 TORRANCE, CA 90805 FOB Point: Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Tina Gray Special Inst: Confirming? NO Quantity Uriit Descri tion - Unit Price Ext. Price Third Party Claims Administration for 200,000.00 Workers' Compensation Contract Addendum Completion date: February 28, 2014 SUBTOTAL 200 000.00 BILL TO: Account Payable _ TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 200,000.00 ASHLAND, OR 97520 Account Number Project Number Amount_ Account Number , Project Number - Amount E 720.03.00.00.60714 200 000.00 i u-c~ ~ 1/rte. UL° ~ to vt.F/ Authors d Signature VENDORCOPY ,F0 RM#3 CITY OF A request fo a Purchase Order ASHLAND REQUISITION Date of request: EEL Required date for delivery: Vendor Name TP-f-STA , 4($~ ?Aly'A/7-7, l1T Address, City, State, zip °170 W I'Y- Cr -A AI, "07 Contact Name & Telephone Number /N ~ ~ /11 71 ~ 3 a~`j~~ 1Z'? Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5,000 Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date a proved by Counc'I; Contract # ❑ Verbal/Written quote(s) or proposal(s) Mtf `I . 1` elel ❑ 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 # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Form #g, Request for Approval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Dale approved by Council: (Dale) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost '3, Fey t 3 #A 4 .2 S f. it a Item # Quantity Unit Description of MATERIALS Unit Price Total Cost' ?ITOTAL<CO itl,'7 ❑ Per attached quotelproposal $ Project Number Account Numberw~Lt•~~-~~{~~-(t~~/~O _••,s` AccountNumber-__-__- 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 ninng'thii~s requi'sirp form,II certify that the City's public contracting requirements have been satisfied. Employee Signature: 4i1#l ~4/-`I" Department Head Signature: reater tl ~n $5,000) _ City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YE / NO ~LJIIAJ kv ( L q ce Director- (Equal to orgmater then $5,000) Date Comments: Form #3 - Requisition