HomeMy WebLinkAbout2014-034 Contract - OR Consensus-Portland State University
26003 / 196015
Contract for PERSONAL SERVICES less than $35,000
CITY OF CONSULTANT: Oregon Consensus/ Portland SIM@ State Boat
-ASHLAND University of Higher Educati n
20 East Main Street acbng'by and throgh
reet CONTACT: Steve Bryant or Savannah HarrOortland State University
Ashland, Oregon St
97520
Telephone: 5411488-6002 ADDRESS: PO Box 751
Fax: 541/488-5311 Portland, OR 97207-0751
TELEPHONE: 541-619-3964
DATE AGREEMENT PREPARED: February 6, 2014 E-MAIL: sb ants comcast.net or slharris dx.edu
BEGINNING DATE: February 1, 2014 COMPLETION DATE: March 31, 2014
COMPENSATION:
Not to exceed $5000. See attached task-hour allocation and budget estimate for details.
SERVICES TO BE PROVIDED: Agenda preparation, individual interviews with Mayor, Administrator, City
Attorney, and Council members, facilitation, advice, and support during goal setting session on March 8, 2014,
summary and follow up.work after completion of session. See attached Project Proposal.
ADDITIONAL TERMS:
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
0from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
/10 - injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
/F 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 b Consultant to perform work or services
Contract for Personal Services, Revised 06130/2013, Page 1 of 5 1 9 Subject to the limits of ORS 30.260-
30.300 and the Oregon Constitution
Article XI, Section 7. 1,4r- /P
2b 5 (14
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.
10. Termination:
t 'aI' Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
It, +:1% • ' ~ b: f City s Convenience. This contract maybe terminated at anytime 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 dale 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
$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 $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 $200,000,
{ Contract for Personal Services, Revised 06/3012013, Page2 of 5
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 Consultant or its insurer(s) to
the City.
e. 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 andlor 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 Stale 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
Slates 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.
17. 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 an herein incorporated b reference.
Consultant; Clty~ Miand
By lC ey o Y ~~t
Signature Dep rtnentHead
William.C.Ter oL05 f<~~~~Z
q~e ABF
Por&; to a University Print Name
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. t`
Contract for Personal Services, Revised 0613012013, 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 1
enforceable in accordance with its terms,.(c) the work under the Contract shall be performed in I
t
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:
✓ (1),f 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.
v/ (5) Labor or services are performed for two or more different persons within a period of one
year.
(6) `laa s a financial responsibility for defective workmanship or fdrservice'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.
The State Board
of Higher Education'
3, ing I- and through
Pgrtland State niversity
Contractor William C• , rry (Date)
Cantra Icer
Portland State University,
Contract for Personal Services, Revised 0 6/3 012 0 1 3, Page 4 of.5
OREGON
Coj, S SUS NATIONAL POLICY CONSENSUS CENTER
Huifcld School Of Covemmeni
Memorandum
To: Dave Kanner, Ashland City Administrator
From: Laurel Singer, Oregon Consensus Program
Date: January 22, 2013
Re: DRAFT Ashland City Council Goal Setting Project Proposal
The following is a proposal for the Oregon Consensus Program (OC) to facilitate a visioning/goal
setting workshop for the Ashland City Council. This memo includes background information, an
outline of proposed tasks/timeline, and a not-to-exceed budget. A detailed task/hour allocation is
also attached. Please feel free to contact me if you have any questions, comments or concerns.
Background and Overview
The Ashland City Council is midway through a two-year budget cycle, and would like to do some
goal setting through a facilitated visioning workshop. In 2009 the City Council participated in a
similar workshop facilitated by Steve Bryant.
Tasks and Timeline
OC recommends an assessment and a one day facilitated goal-setting workshop. The steps and a
tentative timeline of the project follow:
Task 1: Interview city councilors and administrative staff on March 6 and 7, 2014 to assess mid to
long-term goals and priorities, including areas of agreement among councilors and staff. The task
includes the compilation of a verbal summary report for councilors' use at the beginning of the
visioning/goal-setting workshop.
Task 2: Facilitate a one day visioning/goal-setting workshop with the City Council, Mayor, and City
Administrator on March 8, 2014. This task includes planning, facilitation, and seeking of consensus
agreement on high priority mid and long-term goals for the city of Ashland.
Staffing
The project team completing the identified tasks will be comprised of OC staff, led by Project
Manager, Steve Bryant.
OC is Oregon's official program for public policy consensus building. OC serves as a neutral forum
to promote effective and efficient approaches for collaborative governance on public policy issues in
Oregon and provides services including consensus building, facilitation, mediation and other confect
DRAFT ArblanAGoal Selling SeopeoJlf/ak.doc Page 1 oft
DRAFT 1-14-13
resolution services to public entities and their stakeholders in Oregon and throughout the
Northwest. OC is a program of the National Policy Consensus Center in Portland State University's
Hatfield School of Government and a program of the Oregon Solutions Network. OC is also a
member program of the University Network for Collaborative Governance, a national association of
university-based centers recognized for their leadership in advancing the best practices for
collaborative approaches to resolving public issues. More information is available at
htip://xvww.orconsensus.12dx.edu.
Budget
The budget to complete this project is not to exceed $5,300. A detailed task/hour allocation and
expense report accompanies this proposal.
DHAFTArbland Goal Setting Scope of lflork.doc Page 2,of 2
OREGON CONSENSUS PROGRAM
TASK-HOUR ALLOCATION AND BUDGET ESTIMATE
Note: Task hour allocations herein are estimates only - actual allocation of hours among tasks may differ from estimates.
Ashlantl Gaal Setting
F,AC ILTITATION]B U OG ETjSUMMARY
LABOR COSTS $ 4,500.00
OTHER DIRECT AND INDIRECT COSTS $ 450.34
TOTAL BUDGET $ 4,950.34
T'ASK:HOURTALLOCATIONIC HART
OC Projed
Task Manager
=I II InteryieW'COu ncll lan d~Staff
1.1 Background research on prior city goals 2
1,2 Schedule interviews vdth council and staff 2
1.3 Interview council and staff includes travel time 17
1.4 Analyze interview responses and compile summa report 4
SUBTOTAL 25
2 F,acllltalelGoaLSet ing;Sesslon
21 Facilitate retreat 8
2.2 Pre are summa and next steps document 3
SUBTOTAL 11
i3l®
SUBTOTAL 0
LTTABORTCOSTS =Hours ~Rat7 =STilitotal=
OC Project Manager 36 $ 125.00 $ 4,500.00
Total Hours 36 $ 4,500.00
TOTAL LABOR $ 4,500.00
OTRERTDIRECT[ANDTINDIRECTICOSTSTODC`s I<Units~ ~CO'stlllnlt' ®~$ubtotal~
Travel (2.5 days per diem) 2.5 $ 52 $ 130.00
Travel (1 round trip mileage) 438 $ 1 $ 245.28
SUBTOTAL $ 375.28
PSU administrative fees (20%of ODCs) $ 75.06
TOTAL OTHER DIRECT AND INDIRECT COSTS $450.34
Grand total $ 4,950.34
2262014 CSDacuments and SettirgslshipleVALocal Settings\Temperary Internet Files\Content. Oullook43N77SLGRAshland Goal Setting Budgetxlsx
PSU Contract #
Refer questions to:
Oregon University System IC Oregon University System
Office of Risk Management Orc n PO Box 751, CHAN
503-798-9976 g°
Un ~rs q- Portland, OR 97229-0751
marv.robinson@ous.edu Syncm
r~
~ s~ ,p CERTIFICA~TEIOF SELF-INSURArNGG~~,"'`~ Certificate
The Oregon University System maintains comprehensive general liability, automobile liability, educators legal liability to include errors & omissions,
and various limited professional liability coverage through a combination of self-insurance and excess insurance programs. Losses that fall within these
retention levels, including those for which we are contractually liable, are covered by the financial resources of the university and are administered under
our self-insurance program.
The Oregon University System is insured for its Workers Compensation coverage through the SAIF and a separate certificate may be obtained as
evidence of this coverage.
CERTIFICATE ISSUED TO
City of Ashland
20 East Main Street
Ashland, OR 97520
DESCRIPTION OF UNIVERSITY OPERATIONS RELATED TO THIS CERTIFICATE
The City of Ashland, its elected officials, officers and employees is named as "additional insured" with respect to their interests, to the
extent Oregon University System can indemnify, the certificate holder, subject to Article XI, Section 7 of the Oregon Constitution, the
Oregon Tort Claims Act (ORS 30.260-30.300), and ORS 351.086, but only with respect to liability arising out of the. negligent or
wrongful acts or omissions of the State of Oregon, acting by and through the Stale Board of Higher Education, on behalf of the Oregon
University System and Portland State UniJersi
Type of Insurance Policy # Effective Date Policy Limits
Expiration
General Liability (Occurrence)
Includes premises, operations, contractual Self-Insured 7/01/2013 7/1/2014 $1,000,000 Per Occurrence
liability, & personal injury fabilily
Automobile Liability Includes all owned,
non-owned, and hired vehicles Self-Insured 7/1/2013 7/1/2014 $1,000,000 Combined Single Limit
Other:
SPECIAL PROVISIONS Contract between Portland State University and The City of Ashland, Oregon, for Portland State Univeristy to
assist the Ashland City Council with Goal Setting Project, beginning February 1, 2014 through March 31, 2014.
Contract: PSU N 26003
Attach Contract for file x Y N (Internal OUS Risk Requirement
SIGNATURE COPIES TO
Client risk management contact and electronic signature Certifiate Holder
OUS Risk Management
Portland State University
Christina McKnight ARM, OUS Risk Control Officer Date: 2/19/14
CI'T'Y RECORDER Page 1 / 1
tk CITY OF
~y ;.~;%DATE, :rYP's'6PONUMBER%?^.I
;
ASHLAND '
,a 20 E MAIN ST. 3/6/2014 12134
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 008088 SHIP TO: City of Ashland
PORTLAND STATE UNIVERSITY (541) 488-6002
BUSINESS AFFAIRS OFFICE 20 E MAIN STREET
PO BOX 751 - BAO ASHLAND, OR 97520
PORTLAND, OR 97207
FOB Point: Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Dave Kanner - Diana Shiplet
Special Inst: Confirming? NO
Quanti F --eUnit. UnrtPncExt<Pnce ~'dk:
Agenda preparation, individual 5,000.00
interviews with Mayor, Administrator,
City Attorney and City Council members.
Facilitation of goal setting session on
March 8, 2014 and follow up summary
after session.
Contract for Personal Services
Beginning date: February 1, 2014
Completion date: March 31, 2014
SUBTOTAL 5 000.00
BILL To: Account Payable rax 0.00
20 EAST MAIN ST HT 0.00
541-552-2010 FREIGHT
5,000.00
ASHLAND, OR 97520
"AccounfNiimtier m,,,;'~Broject Number„ °.K"Amount :.'AccounfNumber, Project'Number,
E 710.01.01.00.60410 5,000.00
Auth ed Signature VENDOR COPY
',l
I FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: 3 3 7'~
Required date for delivery:
Vendor Name re oA o 94mir nsu
Address, City, State, Zip 'f.'Q O S~ 0 012 Gi 7 - 7,tL
Contact Name & Telephone Number, S
Fax Number
S0,3 -
a5- Sl ~a
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on f le) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached
LL -small Procurement Cooperative Procurement
Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
[r}fSrect Avg Date approved by Council: Contract #
[9'Verba riff ote(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 #
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 proposalstwritten solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
rc?A" K-'~
!`~p r r~_- t 3
Item # Quantity Unit Description of ATERIALS Unit Price Total Cost
~'^.GTOTAL COST
❑ Per attached quotelproposal F
Project Number Account Number-7W.DI-0 1 -oU-(p0~(U~ p4^ y ~ 7
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:
T DirectorL'Date Support-Yes/No
By signing this re/fib form, I certify that he 2 'r public contracting requirements have been satisfied- I Employee: i Department Head: ~t
(Equal to or greater than $5,000)
Department Manager/Supervisor: City Administrator:
1 (Equal to or greater than $25,000)
Funds appropriated for current riscal year. Cx s / NO S 3V7//1f
Finance Director (Equal to orgre than $5,000) Date
Comments:
i
Form #3 - Requisition