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HomeMy WebLinkAbout2014-038 Contract - Hardey Engineering Contract for PERSONAL SERVICES less than $35,000 CITY OF CONSULTANT: Hardey Engineering & Associates, Inc. ASHLAND CONTACT: John Hardey 20 East Main Street Ashland, Oregon 97520 ADDRESS: PO Box 1625, Medford, OR 97501 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-772-6880 DATE AGREEMENT PREPARED: 02/202014 FAX: n/a BEGINNING DATE: 03/0312014 COMPLETION DATE: 12/31/2015 COMPENSATION: Time and materials, not to exceed $21,092.00 SERVICES TO BE PROVIDED: see attached Exhibit C 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 I 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, ousts, 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. 10. Termination: a. u I Consent This contract may be terminated at an time b mutual consent of both parties. Contract for Personal Services, Revised 08 2013, Page 1 of 6 b. Citds Convenience. This contract maybe 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. 1. 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 Clty 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 contractor 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: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable 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: $200,000, $500,000, $1,000,000, $2.00,000 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. d. 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. e. Notice of opgglIation or change. There shall be no cancellation material change, reduction of limits or Contract for Personal Services, Revised 00/30/2013, Page 2 of 5 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 fumish 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. 17. Nonapproprlations 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 incur o - Consultant: / l City of Ashland By 5z By Signature Departmen ,IoNN ! I~c2D~ ~ ~ A4 l FA-0-4- Print Name Print Name ~RGSfDGhIT 3/~~~ ~y Title Date W-9 One copy of a W-9 is to be submitted with C d2l ri the signed contract. Purchase Order No. APB D AS TO FORM Ashle Asst"City Aftomey Data. U 3 /a ~l ~ZD 19 Contract for Personal Services, Revised 06/30/2013, 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 noted 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: (1) 1 carry out the labor or services at a location separate from my residence or is in a speck 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) CoMrad for Personal Services, Revised 0100/2013, Page 4 of 5 ~X1-116\T C, - ~ S~teETs 2970 NAN9EN DR. PD Box 1625 M eDFORD, OR 97501 S41.772.01380 HARDEY ENGINEERING da ASSOC. INC. HEA-IND.OOM February 10, 2014 Rob Morris E.I.T. Engineering Technician City of Ashland, Public Works 20 East Main Street, Ashland Oregon 97529 (541) 552.2419 Office (541) 488-6006 Fax Subject: ivy/Morton Waterline Project Engineering and Surveying Services PROPOSED SCOPE OF WORK: We at Hardey Engineering would like to thank you for the opportunity to submit this Proposal for Services. The Scope of Work as we see it at this time is to provide engineering and surveying services for the above mentioned project. The work is more specifically as follows. Item 1-Topo Survey Cost $ 6,592 SURVEY PROPOSAL: (Assumption for this proposal Is that the new water line will run between Waterline Road and West Ivy Lane and only cross Tax Lot 300) Field Work: 1 man- 5 hrs with RTK to set up control at each end of the project and tie In several monuments at each end in order to orient the survey to the subdivision plats. $600 Mark for utilities and call in order = $362 2.0 days topo of existing waterline, improvements, utilities. $2,900 Office: Title report ($200 for TL 300), review report and plot easements. $440 PLS to review tied in survey monuments and compute locations for Waterline Road r/w and West Ivy Lane r/w as well as property lines that may be affected by the location of the water line. $760 Download data collector, sort data, reduce notes and topo points, and plot topo map for internal use only is $1,530. (Does not include acquiring the actual easement or construction staking) Item 2- Engineering Services Cost $ 11,500 Prepare water plan and profile sheets (three sheets), erosion and sediment control plan. Coordinate with the City of Ashland Public Works Department. Prepare bid documents and construction cast estimate. Item 3 - Easement Acquisition Services Cost $1,500-3,000 We are considering two different alternate locations for the tie from Ivy Street to the existing waterline easement location. The preferred alternate is to cross only one parcel, 391E16AC TL300, and acquire only one easement. If that land owner is not readily agreeable to having a waterline and easement on that parcel we will evaluate an alternate connection which will cross two parcels. Hopefully we can find agreeable land owners to allow one of the above crossings. If not we will need to go beyond this scope to find alternate solutions. MEDFORD I BEAVERTON I HOUSTON TUAOITION.GL PRINCIPLES - MODERN Ari,PDFON 1. Our approach is to work up an exhibit map for the preferred alternative and contact the owner to see if they are receptive to the proposal. If so we will proceed with preparing the easement and processing it. We have budgeted for staking out the easement location If needed and also recording the easement document. The estimated fee for this work is $1,500-2,000. 2. If the preferred crossing does not work out satisfactorily, we will work up exhibits for the second alternative, and contact those owners to see how receptive they are. If they are receptive, we would need to prepare two easements. The estimated fee if this alternative is needed would be about $2,500-3,000. This amount would include the cost for the exhibit map and coordinating with the owner in Item 1. TOTAL ESTIMATED FEE $19,592-21,092 The above mentioned work will be performed on a time and materials not to exceed basis, estimated to be $19.592-21.092 in accordance with our current billing rates and Standard Contract Provisions which are normally associated with a project of this nature and does not include any survey work and or geotechnical work, structural design, full-time inspection services and fees for permit applications, filing, etc. that may be required by government agencies as part of the approval of the construction process. If we anticipate our fees to exceed the estimate, we will notify you with an explanation as to why the excess is anticipated. We will not exceed the budgeted amount without your prior approval. If this proposal meets with your approval, please have an authorized representative or owner sign, date and return one copy to this office. By signing, both Hardey Engineering & Associates, and the owner will be bound to the other party to this agreement and to the partners, successors, executors, administrators and legal representatives of such other party in respect of all covenants, agreements and obligations of this agreement. We will proceed with work upon receipt of the signed Contract for Services. Thank you for the opportunity to submit this Proposal for Services. We are looking forward to the opportunity to serve you on this project if you have any questions, please do not hesitate to call. HARDEY ENGINEERING & ASSOCIATES, INC. City of Ashland By: Authorized Signature Title: ~✓65:~~Y Title: Date 2-Z-7- 14- Date: WARRANTY OF AUTHORIZATION - The person signing this authorization, accepting this proposal, warrants he/she has authority as, or o„ behalf of, the client, Owner, Partnership, or Corporation for whom or for whose benefit Hartley Engineering & Associates, Inc. Would render service. -Sald~pareowegrees 4d a If ettolift . per- 11.hl~ 1- W-1,1 It the -,d that Nil"A" 1111/11" 1010-11 W W21FORtY /i ewus ee a! oil In -RV -J HEA IPAr3E 2 cIF 2 HARDE-1 OP ID: KIY CERTIFICATE OF LIABILITY INSURANCE °A~WWDO1' 0212812014 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 pollcy(les) must be endorsed. H SUBROGATION IS WANED, 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 Phone: 541-7735358 CONTACT Kendall Yeaw Protectors Insurance, LLC PHNAME: ONE Pilot Rock Ins Agency LLC ICA) Fax: 541-772-1906 _ Arc No E : 5x1.642-2963 No : 541.772-1906 PO Box 4669 ` kendall rotectorsins.com Medford, OR 97501 ADDRESS: R. Joe Hubbard INSURER(S) AFFORDING COVERAGE NAICi INSURER A: SAIF Corporation INSURED Handley Engineering & Assoc Inc INSURERS: Ohio Security Insurance PO Box 1625 INSURER C:CNA Continental Casual Co Medford, OR 975 01-01 24 INSURERO:Ohio Casual Insurance INSURER E 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. TYPE OF NSURANCE POLICY NUMBER FOCICY LIMITS LTR Was WVD (MWDDfCff(1 20141 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY X BZ855569489 0511272013 05I1212014 PREMISES Ea occurrence $ 1,000,00 cLnlMSrnnDE ~X OCCUR MED EXP (Anv one Person) 5 15,00 PERSONAL & AOV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMTAPPLIES PER. PRODUCTS - COMP/OP AGO $ 2,000,DO POLICY X PRa 1-1 LOC $ 17 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidem) $ 1,000,00 B X ANYALHI SAS55569489 051122013 0511212014 BODILY NJURY(Perperedn) $ ALL OWNED X SCHEDULED BODILY INJURY (Per eccidem) $ X HIRED AUTOS X q~O~D I (per PROaccaefDAMAG $ X UMBRELLA ALAS X OCCUR EACH OCCURRENCE $ 1,000,00 D EXCESS LAS CLAIMS-MADE US055569489 0170812014 05/12)2014 AGGREGATE $ DIED RETENTION $ WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS' LIABILITY YfN TORY LIMITS ER A ANYPROPRIETOWARTNERIEXECUTIVE 943247 07101/2013 0710112014 FL EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatorym NH) E. L. DISEASE - FA EMPLOYEE $ 1,000,00 HAS desrnee under 0 IfRIPTIONOFOPERATIONSOebn E1. DISEASE-POLICY LIMIT $ 1,000,00 C Professional AEA11386365 01202014 0120)2015 2,000,00 Liability DESCR 014 OF OPERATIONS 1 LOCATIONSI VEHICLES (Aeach ACORD 101, Adtllllonal Remarks Schedule, If mom space Is mculmd) additional insured per policy endorsement BP7996(0609) for General Liability: CERTIFICATE HOLDER CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE R. Joe Hubbard 101888-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010!05) The ACORD name and logo are registered marks of ACORD Page 1 / 1 CITY OF CI°('y+ RECOR ASHLAND CITY DATE PO NUMBER 20 E MAIN ST. 3/12/2014 12143 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 001718 SHIP TO: Ashland Public Works HARDEY ENGINEERING 8, ASSOCIATE, INC (541) 488-5587 P O BOX 1625 51 WINBURN WAY MEDFORD, OR 97501 ASHLAND, OR 97520 FOB Point: Req. No.: Terms: Net Dept: Req. Del. Date: Contact: ROB MORRIS Special Inst: Confirming? No Quanti Unit Description Unit Price Ext. Price ENGINEERING AND SURVEYING SERVICES TO 21,092.00 DESIGN IVY-MORTON WATERLINE PROJECT CONTRACT FOR PERSONAL SERVICES BEGINNING DATE: 03/03/14 COMPLETION DATE: 12/31/15 SUBTOTAL 21092.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 21,092.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 670.08.18.00.70420 E 201404.100 21 092.00 Auth ed Signature VENDOR COPY FORM#3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: 03/11/14 Required date for delivery: ASAP Vendor Name Hardey EnginApHng P. Accnriatcq Inr Address, City, State, Zip P,0 Box 1625. Medford. OR 97501 Contact Name & Telephone Number John Hardey (541) 772-6880 Fax Number n/a SOURCING METHOD ❑ Exemot from Comoetitive 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 # ❑ VerballWritten 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 El Form #4, Personal Services $5K to $75K Contract # rgovernmental Agreement PERSONAL SERVICES ❑ Special Procurement ]Eta $5,000 to $75,000 ❑ Form #9, 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 Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid unt(Date) I Description of SERVICES Total Cost I I I 4, I Engineering and surveying services to design Ivy-Morton waterline project. Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST Per attached quotelproposal Project Number 2014.04 Account Number 670-08.18.00-704200 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 By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. - / Employee: Department Head: J (Equal to a n$5,000) Department nager/Supervis City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year E / NO a 3 Z-// el Finance Director- (Equaltoorgreathan$5,000) Date Comments: Form #3 • Requisition