HomeMy WebLinkAbout2013-399 Contract - Lomakatsi Restoration Project
Contract for PERSONAL SERVICES less than $35,000
CITY OF CONSULTANT: Lomakatsi Restoration Project
ASHLAND CONTACT: Justin Cullumbine
20 East Main Street.
Ashland, Oregon 97520 ADDRESS: PO Box 3084 Ashland, OR 97520
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: (541) 488-0208
DATE AGREEMENT PREPARED: 11/21113 FAX: justin@lomakatsl.org
BEGINNING DATE: 11/26/13 COMPLETION DATE: 12/31/13
COMPENSATION: Up to $5,000
SERVICES TO BE PROVIDED: Services include community engagement activities pertaining to the Ashland
Forest Resiliency Project as described in Exhibit C: Scope of Work and Deliverables.
ADDITIONAL TERMS: None
FINDINGS:
Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the undersigned Department Head finds and
determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor
resources to perform the services; (3) the statement of work represents the department's plan for utilization of such
personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient
to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints
provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein
is fair and reasonable.
NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as
follows:
1. Findings / Recitations. The findings and recitations set forth above are true and correct and are incorporated herein
by this reference.
2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described
above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance
of such service.
3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel
assigned to the work required under this contract are fully qualified to perform the service to which they will be
assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of
Oregon, are so registered, licensed and bonded.
4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated
above and complete the service by the completion date indicated above.
5. Compensation: City shall pay Consultant for service performed, including costs and expenses, the sum specified
above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely
terminated, payments will be made for work completed and accepted to date of termination.
6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of
City.
7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract.
8. Living Wage Requirements: If the amount of this contract is $19,825 or more, Consultant is required to comply with
chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees
performing work under this contract and to any Subcontractor who performs 50% or more of the service work under
this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where
it will be seen by all employees.
9. Indemnification: Consultant agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
whatsoever nature arising out of or incident to the performance of this contract by Consultant (including but not
limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services
attendant to this contract). Consultant shall not be held responsible for any losses, expenses, claims, subrogations,
actions, costs, judgments, or other damages, directly, solely, and proximately caused,by the negligence of City.
Contract for Personal Services, Revised 06/30/2013, Page 1 of 6
10. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Cm'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 Consultant, 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
. sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Consultant to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Consultant may terminate this contract in the event of a breach of the contract by
the other, Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Consultant's performance of each and every obligation and duty under
this contract. City by written notice to Consultant of default or breach may at any time terminate
the whole or any part of this contract if Consultant fails to provide services called for by this .
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Consultant shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice-of termination. Further, upon termination,
Consultant shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Consultant for work performed prior to
the termination date if such work was performed in accordance with the Contract.
11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City.
Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide
workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to
this contract. Consultant is a subject employer that will comply with ORS 656.017.
12. Assignment and Subcontracts: Consultant shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Consultant shall be fully responsible for the acts or omissions of any assigns or Subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default
of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF
Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if
consultant has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted
against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business
on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or
delegate duties under, the Contract.
14. Insurance. Consultant shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. Professional Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$1,000,000 for each claim, incident or occurrence. This is to cover damages caused by error, omission or
negligent acts related to the professional services to be provided under this contract.
C. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$1.000.000 for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability
coverage for the indemnity provided under this contract.
d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$1.000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-
owned vehicles, as applicable.
Contract for Personal Services, Revised 06/302013, Page 2 of 6
e. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Consultant or its insurer(s) to
the City.
f. Additional Insured/Certificates of Insurance. Consultant shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Consultant's services to be provided under this Contract. The consultant's insurance is primary and
non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish
acceptable insurance certificates prior to commencing work under this contract. The certificate will specify all of
the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies; trust agreements, etc. shall be provided to the City. The
Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
15. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Consultant that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Consultant, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
16. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
1T Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Consultant
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Consultant, with no further
liability to Consultant.
Certification.. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated by reference.
Bynsultan~sG%~City of Ashland
l By Signature Departme t Head
M Uyko JCJ H/V Xlk-kA;23
Print Name y Print Name
C X-eCV f,u,n 13
Title Date
W-9 One copy of a W-9 is to be submitted with 4~1 a;:
the signed contract. Purchase Order No.
ALPS zlcl S T ORM
Attorney
DafAJ - a 7 - f 3
Contract for Personal Services, Revised 06/30/2013, Page 3 of 6
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:
v (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.
V/
(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.
V (6) I 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 Personal Services, Revised 0613012013, Page 4 of 6
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
WAGE
I NO
per hour effective June 30, 2013
(Increases annually every June 30 by the
Consumer Price Index)
portion of business of their cafeteria plans (including
employer, if the employer has childcare) benefits to the
ten or more employees, and amount of wages received by
has received financial the employee,
assistance for the project or
➢ For all hours worked under a business from the City of ➢ Note: "Employee" does not
service contract between their Ashland in excess of $19,825. include temporary or part-time
employer and the City of employees hired for less than
Ashland if the contract ➢ If their employer is the City of 1040 hours in any twelve-
exceeds $19,825 or more. Ashland including the Parks month period. For more
➢ For all hours worked in a and Recreation Department. details on applicability of this
policy, please see Ashland
month if the employee spends ➢ In calculating the living wage, Municipal Code Section
50% or more of the employers may add the value 3.12.020.
employee's time in that month of health care, retirement,
working on a project or 401 K and IRS eligible
information-
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen. by all
employees.
CITY OF
ASHLAND
Contract for Personal Services, Revised 06/30/2013, Page 5 of 6
Exhibit C: Scope of Work and Deliverables
Scope of work /Deliverables due prior fo December 31, 2013
• Create Fall/Winter version of the "Ashland Watershed Update" newsletter
• Update the Ashland Forest Resiliency Community Engagement Plan to
reflect completed tasks and identify remaining and ongoing tasks with
updated timelines and responsibility.
• Assist in the creation and distribution of various forms of outreach
including:
o email correspondence with AFR stakeholders
o printed notifications/signs as needed
o Facebook updates
o Burn notifications
o Updates to the AFR webpage
• Help organize any community and volunteer events, or plan events for the
future
• Attending meetings and recording meeting minutes
• Compile AFR photo database by soliciting photos from all AFR partners and
posting them for joint access. .
• Prepare materials for the end-of-the year review document as needed.
Contract for Personal Services, Revised 06/30/2013, Page 6 of 6
LOMAK4 OP ID: KIY
CERTIFICATE OF LIABILITY INSURANCE o oiiszo
THIS CERTIFICATE 1S 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
REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(las) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, Certain policies may require an endorsement. A statement onthis certificate does not confer rights to the
certificate holder In lieu of such endorsement s). - t
PRODUCER CONTACT
Phone: 541-7735358 We CT
Protectors Insurance, 'LLC PHONE Fc
P11ot Rock Iris Agency LLC (CA) Fax: 541-772-1906 Alc Nd E :541.842-2963 Np 541-772-1906
PO Box 4669 DDRES
AS: k doll rotectdrsins:CODI
Medford, OR 97501 -
R.JoeHubbard INSURER(S) AFFORDING COVERAGE NAIC3
INSURER A; American States Ins Company 19704
INSURED LomakatsiRest-oration Project INSURERB -American. States of Texas
PO Box 3084 INSURERC; SAIF Corporation
Ashland, OR 97520
INSURER D : _
INSURERE:
INSURER 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
LTR TYPEOFINSURANCE POLICY NUMBER (MMDNYYY) (MMDNYYY) xP LIMITS
INSR GENERAL UABIL" EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LLABILRY .X 25CC16OD447 0411712013 D411712014 'pREMIBES Ee occurrence L 1,000,00
CLWMS-MADE [X] O OCCUR NED EXP(Any we perew) $ 10,000
X Owner/Cont Prot. PERSONAL a ADV INJURY $ 1,000,00
X Loggers BFPD GENERAL AGGREGATE $ 2,000,00
GENT AGGREGATE LIMIT APPLIES PER' PRODUCTS-COMPIOP AGG $ 2,000,00
POLICY X PRO- LCC. $
. F7 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
B ANY AUTO 04CC2285274 04117/2013 .04/1712014 BODILY INARY(Per person) $
Al ffs OWNED X ~OEOILED - BODILY INJURY (Per accident) $
X HIRED AUTOS X SOS D P.,.dAdW GE $
$
UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,0.0
A ExcESSLM CLAJ,MSMADE OISU3691439 04117/2013 04117/2014 AGGREGATE } 2,000,00
DED X RETENTION 10,000 $
WORKERS COMPENSATION X WCSTATU- OTI+
AND EMPLOYERS'LIABILIY TORY IMITS
C ANY PRoPREroR,PARTNERExEcunvE YIN 992153 04101/2013 0410112014 E,L. EACH ACCIDENT $ 500,000
OFFICERMIEMBER EXCLUDED? E] NIA
1Menda[pry I. NH) E.L. DISEASE-EA EMPLOYEE $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS belay E.L. DISEASE-POLICY LIMB $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaach ACORD 101, Additional RemaMa Schedule, If mare apace le required)
As additional insured per policy endorsement CG7635(0207):
CERTIFICATE HOLDER CANCELLATION
CITYAS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main Street _
Ashland, OR 97520 AUrHORREO REPRESENTATNE
R. Joe Hubbard
0.1988-2010 ACORD,CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name.and logo are registered marks of ACORD
Page 1 / 1
11'1 V C~~'~
P. CITY OF
ASHLAND DATE PO NUMBER
20 E MAIN ST. 12/5/2013 11992
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 006637 SHIP TO: Ashland Fire Department
LOMAKATSI RESTORATION PROJECT (541) 482-2770
PO BOX 3084 455 SISKIYOU BLVD
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Chris Chambers
Special Inst: Confirming? No
Quantity Unit - - Description Unit Price' Ext. Price
Community "engagement services 5,000.00
pertaining to the Ashland Forest
Resiliency Project as described in the
attached scope of work.
Contract for Personal Services
Beginning date: 11/26/2013
Completion date: 12/31/2013
SUBTOTAL 5 000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 5,000.00
ASHLAND, OR 97520
"Account Number Project Number Amount Account Number: Project Number Amount
E 670.07.29.00.60416 E 000199.400 5,000.00
.Gt /z S l~
Auth zed Signature VENDOR COPY
FORM#3, CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: 12.3.13
Required date for delivery:
Vendor Name L mak fc' n f r a art
Address, City, State, Zip P.O Box 3084 Ashland OR 97520
Contact Name & Telephone Number Justin Cullumbine (541) 488-0208
Fax Number justin@lomakatsi.org
SOURCING METHOD
El 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
❑ Wdtten quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than $5,000 ❑ west for Proposal (Copies on file) ❑ State of Oregon
❑ Dired Award Date approved by Council: Contract #
❑ VerbalMritten quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ Applicable Form (0,6, 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 #9, Request for Approval ❑ Agency
M 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
Services include community engagement activities pertaining to the
Ashland Forest Resiliency Project as described in Exhibit C: Scope of
Work and Deliverables. Up to $5;000
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quotelproposal $5,000
i
Project Number 000199.400 Account Number 670.07.29.00.604160
Account Number AccountNumber___-__-__•__-______
'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: , Department Head: i7 "x Cam' d
(Equal to or greater than $5,000)
Department Manager/Supervisor: tyadministrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year: ES NO Q~?i 2 s-
Finance Director- (Equal toorgrealrrthan$5,000) Date .I
Comments:
i
Form #3 - Requisition