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HomeMy WebLinkAbout2013-310 CONT Addendum - Hays Oil ADDENDUM TO CITY OF ASHLAND CONTRACT FOR FUEL - ASHLAND PARKS & RECREATION Addendum made this 23rd day of August, 2013, between the City of Ashland ("City") and Hays Oil Company ("Contractor"). Recitals: A. On September 10, 2012, City and Contractor entered into a "City of Ashland Contract for Fuel" (further referred to in this addendum as "the agreement'). B. The parties desire to amend the agreement to extend the contract for one additional vear. City and Contractor agree to amend the agreement in the following manner: 1. The contract is being extended one additional year ending June 30, 2014. 2. Except as modified above the terms of the agreement shall remain in full force and effect. CONTRAC O CIT F ASHLAND: BY BY C~~ L~- ep irtment Head Its Date q 3 , ~ 3 DATE 147 Purchase Order # Acct. No.:152--// (For City purposes only) 1- CITY OF ASHLAND, ADDENDUM TO CONTRACT FOR FUEL www.salf.com OREGON WORKERS COMPENSATION 0 0 Sal CERTIFICATE OF INSURANCE corporation MAIL TO: CERTIFICATE HOLDER: R W HAYS CO CITY OF ASHLAND PO BOX 1220 90 N. MOUNTAIN AVENUE MEDFORD, OR 97501-0091 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 480084 07/01/2013 to 07/01/2014 08/30/2013 INSURED: BROKER OF RECORD: R W HAYS CO PO BOX 1220 MEDFORD, OR 97501-0091 LIMITS OF LIABILITY: Bodily Injury by Accident $1,000,000 each accident Bodily Injury by Disease $1,000,000 each employee Body Injury by Disease $1,000,000 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. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE. AUTHORIZED REPRESENTATIVE 3r President and CEO 400 High Street SE Salem, OR 97312 P: 800.285.8525 F: 503.373.8020 Polity ceniFlcates_certiflcate0nnsu2nce CERTIFICATE OF LIABILITY INSURANCE 6/DATE (MMIDDNY 25/2013W) 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 CONTACT Pam Winner NAME: . (503)227-1771 FAX . (503)274-7644 Elliott Powell Baden and Baker Inc. 5, N 1521 S.W. Salmon Street E-MAIL pwinnes@eplob. tole RES, INSURER(S) AFFORDING COVERAGE NAIC Portland OR 97205-1783 INSURERA:Continental Western Insurance INSURED INSURER B . RW Hays Co, DBA: Hays Oil Company INSURER C: PO Box 1220 INSURER D: INSURER E' Medford - OR 97501 INSURER F: COVERAGES CERTIFICATE NUMBER:13-14 GL,Auto, Umb 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. TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR N POLICY NUMBER MMIDDIYVYV MMIDDIYYYV GENERALLIABILITV EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMSMADE ®OCCUR X DP2938039 /1/2013 /1/2014 MED EXP(Any ane(R.rsnn) $ 5,000 PERSONAL 3 ADV INJURY $ 1,000,000 GENERAL AGGREGATE 8 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS- COMPIOP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 Ix ANY AUTO BODILY INJURY )Par $ A ALL OWNED SCHEDULED DP293BO39 /1/2013 /1/2010 BODILY INJURY Per accidenq $ AUTOS qNI1TONDWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS Per accident D X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 A EXCESS LIAR CLAI MSMADE AGGREGATE $ 10,000,000 DED RETENTIONS 02938040 /1/2013 /1/2014 $ WORKERS COMPENSATION W STATUS O H- AND EMPLGYERS'LIA BILITY YIN RY ANY EXCLUDED~IXJTIVE L NIA E.L. EACH ACCIDENT $ O FRCEAMEMEER1OPARTNERI (Mndetory in NH) E.L. DISEASE- EA EMPLOYE $ If yes, dxscrihe uudnr DESCRIPTION OF OPERATIONS Inluw E.L. DISEASE - POLICY LIMIT $ -1 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach AC0RD 101, Additional Remarks Schedule, lmore apace is required) Re: Delivery of Fuel. Additional Insured Endorsement Cw 34 fib (01/10) is attached. CERTIFICATE HOLDER CANCELLATION (541) 488-5320 - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 90 N Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE . Pam,Wimner/LT ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 r7ntnnslni The Ar.npn namR and In nn Are rnni.tcred Tl r,f Ar.oRn CDP 2938039 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL AUTOMOBILE EXPANSION ENDORSEMENT - PLATINUM This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following provides a broad range of coverage in addition to that provided by the basic policy. In some instances, a higher limit or broader coverage is available. Should the policy indicate broader coverage or higher limits than provided by this endorsement, the higher limits or broader coverage shall apply. A. BROADENED NAMED INSURED those specified In the written con- The Named Insured shown in the Declarations is tract or agreement, or in this cover- amended to include: age form, whichever is less. These limits of insurance are inclusive of Any organization, other than a joint venture, over and are not In addition to the Limits which you maintain ownership or majority inter- of Insurance shown in the Declara- est of more than 50%, unless that organization lions. is an "insured" under any other automobile pol- (4) This insurance applies on a primary Icy or would be an 'insured' under such a policy and non-contributory basis if that is but for the exhaustion of its Limit of Insurance, required by the written contract or however: agreement. 1. Coverage under this provision is afforded (5) This insurance does not apply only until the 1 BOth day after you acquire or unless the written contract or form the organization or the end of the policy agreement has been executed prior period, whichever is earlier. to the 'bodily injury' or 'property 2. Coverage does not apply to 'bodily Injury' or damage'. "property damage" that occurred efore you C. ADDITIONAL INSURED -EMPLOYEES acquired or formed the organization. B. ADDITIONAL INSURED BY CONTRACT OR The following is added to the Section 11- Liability AGREEMENT Coverage, Paragraph A.I. Who Is An Insured Provision: The following is added to Section II - Liability Any "employee" or yours is an "insured' while us- Coverage, Paragraph A.1.: ing a covered "aulo' you don't own, hire or borrow d. Any person or organization for whom you in your business or your personal affairs. are performing operations 9 you and such D. EXTENDED COVERAGE - BAIL BONDS person or organization have agreed in writ- ing in a contract or agreement that such Section 11 - Liability Coverage, Paragraph person or organization be added as an addi- A.2.a.(2). Is deleted and replaced by the follow- tional insured on your policy. ing: (1) Such person or organization Is an (2) Up to $3,000 for oost.of bail bonds additional insured only with respect (including bonds for related traffic to liability for *bodily injury' or 'prop- law violations) required because of erty damage-: an "accident" we cover. We do not (a) Caused by an "accident", and have to tumish these bonds. (b) Resulting from the ownership, E. EXTENDED COVERAGE - LOSS OF EARN- maintenance or use of a cov- ING ered'auto". Section 11 - Liability Coverage, Paragraph (2) A person's or organization's status A.2_a_(4) is deleted and replaced by the follow- as an additional Insured exists only ing: while you are performing operations (4) All reasonable expenses incurred by for that additional insured. the "Insured' at our request, includ- (3) Section II, Paragraph C. Limits of ing actual loss of earning up to $500 a day because of time off from work- Insurance for person or organization added as additional insured are CW 34 68 01 10 Includes Copyrighted material of insurance services Page 1 of 5 Office, Inc., with Its permission F: FELLOW EMPLOYEE COVERAGE (3) Security deposits not returned by The Fellow Employee Exclusion contained in the lessor; Section II -Liability Coverage does not apply. (4) Costs for extended warranties, This coverage is excess over any other collect- Credit Life Insurance, Health, Acci- able insurance. dent or Disability Insurance pur- G. AUTO MEDICAL PAYMENTS COVERAGE - chased with the loan or lease; and INCREASED LIMIT (5) Carry-over balances from previous If the 'insured" is wearing a seal belt at the time loans or leases. an "accident" occurs; the LIMIT OF INSUR- K. GLASS DEDUCTIBLE ANCE for AUTOMOBILE MEDICAL PAYMENTS Section III - Physical Damage Coverage, Para- COVERAGE shown in the Declarations will be graph D. is deleted and replaced by the follow- double the limit shown. All other terms and con- ditions applicable to MEDICAL PAYMENTS re- ing: maln unchanged. D. DEDUCTIBLE H. COVERAGE EXTENSION AS A CONSE- For each covered 'auto" our obligation to QUENCE OF THEFT OF AN "AUTO" pay for, repair, return or replace damaged or 1. Transportation Expense stolen property will be reduced by the appli- cable deductible shown in the Declarations. Section III - Physical Damage Coverage, Any Comprehensive Coverage deductible Paragraph A.4.a. is deleted and replaced by shown in the Declarations does not apply to: the following: a. We will also pay up to $75 per day to a 21. 'Loss" caused you fire elect t t to lightning; repair maximum of $2,500 for temporary . 'Loss" when you patch or r transportation expense Incurred by you glass rather than replace. because of the total theft of a covered L. EXTENDED COVERAGE - ELECTRONIC "auto" of the 'private passenger type". EQUIPMENT We will pay only for those covered The following is added to Section III - Physical autos" for which you carry either Com- Damage Coverage, Paragraph A.4.: prehensive or Specified Causes of Loss Coverage. We will pay for temporary c. Physical Damage Coverage on a cov- transportabon expenses Incurred during ered 'auto' also applies to "loss' to any the period beginning 48 hours after the electronic equipment that receives or theft and ending. regardless of the pol- transmits audio, visual or data signals icy's expiration, when the covered auto" and that is not designed solely for the is returned to use or we pay for its reproduction of sound. This coverage 'loss". applies only if the equipment Is perma- We will also pay reasonable and neces- nently installed in the covered 'auto' at sary expenses to facilitate the return of the time of 'loss" or the equipment is the stolen "auto° to you, removable from a housing unit which is permanently installed in the covered 1. EXTENDED COVERAGE - AIRBAGS auto' at the time of the 'loss", and such Section III -Physical Damage Coverage, Para- equipment is designed to be solely op- graph B.3.a. does not apply to the unintended crated by use of the power from the discharge of an airbag. Coverage is excess auto's' electrical system, in or upon the over any other collectible insurance or warranty covered 'auto". specifically designed to provide coverage. We will pay with respects to a covered J. LEASED OR FINANCED "AUTOS" - PHYSI- "auto' for "toss" to antennas and other CAL DAMAGE COVERAGE accessories necessary for use of the electronic equipment. However, this The following is added to Section III - Physical does not Include tapes, records or discs. Damage Coverage, Paragraph C. M. EXTENDED COVERAGE - PERSONAL EF- 4. In the event of a total 'loss" to a covered FECTS "auto", we will pay any unpaid amount due The following is added to Section III -Physical less: the lease or loan for a covered "auto°, Damage Coverage, Paragraph AA.: le a. The amount under the Physical Damage d. Physical Damage Coverage on a cov- Coverage section of the policy; and ered 'auto' may be extended to "loss" to your personal property or, if you are an b. Any: Individual, the personal property of a (1) Overdue family member, that is in the covered payments at the time of the'loss; "auto' at the time of "loss'. " (2) Financial penalties imposed under a The most we will pay for any one "loss' lease for excessive use, abnormal under this coverage extension is $500. wear and tear or high mileage; CW 34 68 01 10 Includes Copyrighted malarial of Insurance Services Page 2 of 5 Office, Inc., with its permission N. TOWING AND LABOR COVERAGE b. Pay, in addition to the limit set forth in Section 111 - Physical Damage Coverage, Para- P.1. above, up to $500 per day, not to graph A.2. is deleted and replaced by the follow- exceed $3.500 per'loss' for: ing: (1) Any costs or fees associated with If a private passenger type 'auto' or light truck the "loss" to a hired "auto"; and "auto" (0-10,000 Lbs. GVW) is provided both (2) Loss of use, provided it is the con- Comprehensive and Collision Coverage, we will sequence of an "accident' for which pay up to $100 for towing and labor costs in- you are legally liable, and as a result curred each time such 'auto is disabled. How- of which a monetary loss is sus- ever, the labor must be performed at the place tained by the leasing or rental can- of disablement. oern. 0. EXTENDED COVERAGE - CUSTOMIZED Q. RENTAL REIMBURSEMENT COVERAGE FURNISHINGS We will pay for rental reimbursement expenses The following is added to Section III - Physical incurred by you for the rental of an 'auto' be- Damage Coverage, Paragraph AA.: cause of 'loss" to a covered "auto". e. Physical Damage Coverage on a cov- 1. Payment applies in addition to the otherwise ered "auto' may be extended to "lass' to applicable amount of each coverage you custom furnishings including, but not have on the covered "auto". limited to special carpeting and insula- 2, No deductible applies to this coverage. lion, height-extending roofs, and custom murals, paintings or other decals or 3. We will pay only for those expenses incurred graphics. during the policy period beginning 24 hours Our limit of liability for loss to custom after the "loss" and ending, regardless of the furnishings shall be the least of. expiration date of the policy, with the lesser of the following: (1) Actual cash value of the stolen or a. When the covered "auto" has been re- damaged properly; paired or replaced, or (2) Amount necessary to repair or re- b. When the total amount paid under this place the property; or coverage extension reaches $2,500. (3) $500. 4. Our payment is limited to the lesser of the This coverage extension does not apply following amounts: to electronic equipment. a. Necessary and actual expenses in- P. PHYSICAL DAMAGE COVERAGE - HIRED curved. "AUTOS" b. Not more than $75 per day. You may extend the Comprehensive, Specked 5. We will pay up to an additional $300 for the Causes of Loss and Collision coverages pro- reasonable and necessary expenses you in- vaded on your owned 'autos" any 'auto' you cur to remove your materials and equipment lease, rent, hire or borrow from m someone other from the covered "auto" and replace such than your employees partners or members of materials and equipment an the rental their households subject to the following: "auto". 1. The most we will pay in any one "lass" is the 6. This coverage does not apply while there least of $50,000, the actual cash value of are spare or reserve "autos' available to you the "auto" or the cost to repair or replace the "auto", except that such amount will be re- for your operations. duced by a deductible to be determined as 7. If "loss' results from the total theft of a cov- follows: ered "auto" of the 'private passenger type", a. The deductible shall be equal to the we will pay under this coverage only that amount of the highest deductible shown amount of your rental reimbursement ex- for any owned "auto" of the same classi- penses which is not already provided for un- fication for that coverage. In the event der the Physical Damage Coverage Exten- there is no owned 'auto' of the same ston. class cation, the highest deductible for R. DRIVE OTHER CAR COVERAGE any owned 'auto' will apply for that cov- 1. Changes In Liability Coverage erage. b. No deductible will apply to "loss' caused a. Any "auto" you don't own, hire or borrow is by fire or lightning. a covered auto' for Liabllity Coverage while being used by: 2. Coverage provided under this extension will: (1) You, if you are designated in the a. Be excess over any other collectible Declarations as an individual; Insurance; CW 34 68 01 10 Includes copyrighted meeerial or Insurance Services Page 3 of 5 Office, Inc., with its permission (2) Your partners or members. If you owned private passenger type "autos", the are designated In the Declarations deductible shall be $50 for Comprehensive as a partnership or joint venture; Coverage and $100 for Collision Coverage. (3) Your members ar, managers, If you No deductible will apply to loss" caused by are designated In the Declarations fire or lightning. as a limited liability company, E. Additional Definition (4) Your 'executive officers', if you are As used in this section; R. DRIVE OTHER designed in the Declarations as an CAR COVERAGE: organization other than an individ- "Family member" means a person related to ual, partnership, joint venture or lim- the Individual named In R-1.a by blood, mar- ited liability company; and riage or adoption who Is a resident of the indi- (5) The spouse of any person named in vidual's household, Including a ward or faster R.1.a.1. through R.1.a.(4) while a child. resident of the same household. - S. KNOWLEDGE OF OCCURRENCE except: The following is added to Section IV - Business (a) Any "auto' owned by that indtvid- Auto Conditions, Paragraph A.2.: uai or by any member of his or d. Notice of an "accident" Or "loss" will be her household. considered knowledge of yours only if (b) Any "auto" used by that individual reported to you, if you are an individual, or his or her spouse while working a partner, an executive officer or an am- in a business of selling, servicing, ployee designated by you to give us repairing or parking 'autos". such notice. 2. Changes In Auto Medical Payments And e. Notice of an "accident" or "loss" to your Uninsured And Underinsured Motorists Workers Compensation insurer, for an Coverages event which later develops Into a claim The following is added to Who Is An Insured: for which there is coverage under this policy, shall be considered notice to us, Any individual named in R.1.a and his or her but only if we are notified as soon as "family members' are "Insured" while "occupy- you know that the claim should be ad- ing" or while a pedestrian when being stack dressed by this policy, rather than your by any "auto" you don't own except: Workers Compensation policy. Any 'auto" owned by that individual or by any f. Your rights under this policy shall not be "family member". prejudiced if you fail to agive us notice of 3. Changes In Physical Damage Coverage an accident" or "loss , solely due to your reasonable and documented belief Any private passenger type "auto" you don't that the event is not covered by this pol- own, hire or borrow is a covered 'auto" while in icy. the care, custody or control of any individual The following is added to Section IV - Busi- named in RA.a or his or her spouse while a ness Auto Conditions, Paragraph 2.b.: resident of the some household except a, Any 'auto" owned by that individual or by (6) Knowledge of the receipt of docu- any member of his or her household. ments concerning a claim or 'suit' will be considered knowledge of b. Any "auto" used by that individual or his or yours only if receipt of such docu- her spouse while working in a business of ments is known to you, If you are an selling. servicing, repairing or parking individual, a partner, an executive "autos". officer or an employee designated 4. The most we will pay for the total of all dam- by you to forward such documents ages under LIABILITY COVERAGE, AUTO to us. MEDICAL PAYMENTS, UNINSURED MO- T. WAIVER OF SUBROGATION BY CONTRACT TORISTS COVERAGE and UNDERIN- OR AGREEMENT SURED MOTORISTS COVERAGE Is the The following is added to Section IV - Business LIMIT OF INSURANCE shown in the Decla- Auto Conditions, Paragraph A.5.: rations as applicable to owned "autos". 5. Our obligation to pay for, repair, return or We waive any right of recovery we may have replace damaged or stolen property under against any "Insured provided coverage under PHYSICAL DAMAGE COVERAGE, will be this endorsement under B., ADDITIONAL IN- by a deductible equal to the amount SURED BY CONTRACT OR AGREEMENT, but reduced any liononly as respects "loss' arising out of the opera- the largest deductible shown for owned private passenger type -auto appli- , maintenance or use of a covered 'auto' cable to that coverage. If there are no Pursuant to the provisions or conditions of the written contract or agreement. CW 34 fib 01 10 Indudes Copyrighted material of Insurance Services Page 4 of 5 Office, Inc., with its permission U. UNINTENTIONAL OMISSIONS V LIBERALIZATION The following is added Section IV - Business If we revise this endorsement to provide greater Auto Conditions, Paragraph B.2.: coverage without additional premium charge, we We will not deny coverage under this policy if will automatically provide the additional cover- you fail to disclose all hazards existing as of the age to all endorsement holders as of the day the Inception date of the policy, provided such fall- revision is effective in your state. ure is not Intentional. CW 34 68 0110 - Includes Copyrighted maledal of Insurance Services Page 5 of 5 Offlce, Inc., wth Its permission I Loti A Johnson Assistant Account Manager ELLIOTT, POWELL, BADEN & BAKER, INC. Phone: 503-445-8433 Fax: 503-445-8493 lj o luisonpaepbb. com Tell EPBB how I'm doing, PERSONAL - COMMERCIAL - LIFE - HEALTH - BONDS Visit www.epbb.com for all your insurance needs. This communication, including any attachments, is intended for the sole and exclusive use of the addressee and may contain proprietary, confidential, and/or privileged information. If you are not the intended recipient, any use, copying, disclosure, dissemination, or distribution of the information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately and delete this communication by destroying all copies. Page 1 / 1 CITY RECORDER Ashland Park Commission DATE PO NUMBER 20 E MAIN ST. 8/23/2013 00259 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 000414 - - SHIP TO: HAYS OIL COMPANY, RW HAYS OIL COMPANY D PO BOX 1220 MEDFORD, OR 97501 FOB Point: Req. No.: Terms: net Dept.: Req. Del. Date: contact: Bruce Dickens Special Inst: Confirming? NO Quantity Unit Description Unit Price Ext. Price Fuel to be delivered as needed to the 12,000.00 Oak Knoll Shop - FY 2014 UNLEADED FUEL - Mark up $0.181 per qal Ion B5 BIO-DIESEL FUEL - Mark up $0.181 per 12,000.00 qallon Contract Addendum - Extended completion date to June 30, 2014 da)v, a~-13 SUBTOTAL 24 000.00 31LL TO: TAX 0.00 FREIGHT 0.00 TOTAL 24,000.00 Account Number Project Number Amount Account Number: Project Number' Amount E 211.12.04.00.60212 24 000.00 Authorized Signature VENDOR COPY FORM #3 CITY OF A regL16St or a Ptlrchtaise Order ASHLAND REQUISITION Date of request: W 1 Required date for delivery: Vendor Name Address, City, State, Zip t Contact Name & Telephone Number 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 Dale 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 # ❑ VerbslNVritten 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 to 100 000 El Written quote or proposal attached Agency (3) Wntten quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75.000 ❑ Agency ❑ Form #g, Request forApproval ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposalstwritten solicitation Date approved by Council: (Dale) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost c1~ ~~l~/l "Cg~~ 6) ~f ~~top $ Item # 'Quantity Unit Description of MATERIALS Unit Price Total Cost CUltler~ Boa r ~S~l 1 d, coo TOTAL COST ❑ Per attached quotelproposal $ Project Number AccountNumberZfr . j? Dqo~ (G®ZlZU a% 004 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: ITDirector Date Support -Yes/No B~y~ signing this requisition form, l certify that the City's public contracting requirement4have n satisfied. Employee Signature. ~L~UDepartment Head Sig ature: ualto orgreater than $5,000) City Administrator: ww ~ r, ~~I7Ln~ I1_ `Equal to or greater t4a 5,000) Funds appropriated for current fiscal year . V / NO f h4-'- 11 l r U FinA ceDirector-(equaltoorgreat~$5,000) Date I L3 Comments: Form #3 - Requisition