HomeMy WebLinkAbout2014-136 Contract - Kittelson & Associates
Contract for PERSONAL SERVICES less than $35,000
CITY OF CONSULTANT: Kittelson & Associates, Inc.
ASHLAND
20 East Main Street CONTACT: Matt Bell
Ashland, Oregon 97520
Telephone: 541/488-6002 ADDRESS: 610 SW Alder St, Ste 700, Portland, OR 97205
Fax: 541/488-5311
TELEPHONE: 503-228-5230
DATE AGREEMENT PREPARED: 6/3/2014 FAX: 503-273-8169
BEGINNING DATE: 6/3/2014 COMPLETION DATE: 6/12/2014
COMPENSATION: Not to exceed $2,500.00 as per attached proposal.
SERVICES TO BE PROVIDED: Prepare TGM grant application as proposed in exhibit C, attached.
ADDITIONAL TERMS: N/A
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.
10. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Cit 's Convenience. This contract may be terminated at an time b City upon 30 days' notice in writing
Contract for Personal Services, Revised 06/30/2013, Page 1 of 6
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:
$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, $2,000,000 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, $2,000,000, 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 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)
Contract for Personal Services, Revised 06/30/2013, Page 2 of 6
to the City.
f. Additional tnsured/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.
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 and herein incorporated b reference.
onsultann~t: City of Ashland
By By Q -LE
Signature Depart a
7f~✓~D t_-~ti~r M.~c:kut~t 4Z. ra.~Mf
Print Name Print Name
0(~~~-4~0~4 MBA- G^t~Z I is I ~ y
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
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:
(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.
(2) Commercial advertising or business cards or a trade association membership are
/ purchased for the business.
V (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)
Contract for Personal Services, Revised 06/30/2013, Page 4 of 6
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
WAGE
~pe~ hour effective June 30, 2013 ;
(Increases annual y~e'ry June 30 by the ~
Consumer Pmce 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
and Recreation Department. details on applicability of this
➢ For all hours worked in a 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
For additional 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
PHASE 1: TGM GRANT APPLICATION ($2,500)
This phase includes preparation of a Transportation and Growth Management
Program Grant Application for the Siskiyou Boulevard Pedestrian Crossing
Evaluation and Feasibility Study.
• Prepare a draft version of the Microsoft Excel TGM Program Grant Application Form
Cover Sheet and Microsoft Word TGM Grant Application Form, which addresses the six
award criteria for the grant.
• Conduct up to two conference calls with the City of Ashland planning and public work
staff to review application materials.
• Provide a final electronic copy of the Microsoft Excel TGM Program Grant Application
Form Cover Sheet and Microsoft Word TGM Grant Application Form.
This scope does not include preparatory time (graphics and handouts) or attendance time for any
public hearings or meetings. All client requests for additional presentations and meetings of this
nature will be accommodated on a time-and-materials basis and will be considered out-of-scope
work.
Contract for Personal Services, Revised 06/30/2013, Page 6 of 6
Clkmt#: 763494 IGTTEASC
ACORM CERTIFICATE OF LIABILITY INSURANCE °"M(eaY 0"M
6N912014
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, EI(TEiD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTIITE A CONTRACT BETWEEN THE ISSUING INSURER(S~ AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the poliey(les) must be andomed. N 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
earmlcMS holder In lieu of such endwamlent(s).
PRODUCER
labble & Prentice, a USI Co PR WL Eft 206 441-6300 FAX
Np, 610382 528
801 Union Street, Suite 1000 AOORBS: pl.cartrequestOkloconixom ~L LAC. Seattle, WA 98101 INau AFFORMNOCOVERAGE rules
INSURER A: Hartford Casualty Insurance Com 29424
mw1TED BIsuRERa:XLSpecialtyInsurance Company 37885
Klttelaon & tre Inc. INSURER C: Sentinel Insurance Company Ltd. 11000
610 SW Alder r Street, , Suite 700 MaUR D.
Portland, OR 97206
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 CONTRACTOR 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.
MISS ADM SU
TYPE OF OISURANCE INSIR 0 POLICY NUNBER UUMS
LTR A GENERAL UABa)rY 52UUNVK9439 11011201401101201 EpAAcA1HAoccuRRENce $1000000
X CIXNAERCIALGENERAL LIABILITY PPEII~ D $31)0
CLAING-MADE OCCUR / MED EXP (Aly me non $10000
PERSONIL&ADVINAAIY 61.000.000
GMERMLAGGREGATE s2000000
GENL AGGREGATE UNIT APPLIES PER PRODUCTS-COMPAIPAGO $2000000
POLICY X P LOL: $
C AUTOMOBILE UABILnY 52UUNVK9439 11012074 01/01201 m S1,000,000
X ANY AUTO BOOLYDUURY(Pwpenw) $
A TOS AOS O BODILY INJURY (Pereotltlulp $
X HFIEDAUT09 X AUTNDNOWNSD
OS pen E i
$
A X unamm, - uAe X OCCUR 62XHUVK9377 1111101/2014 OV111/201115 EACHOCCURRENCE $5,000,000
EXCESS LIAB CIAWB-MADE AGGREGATE $5,000,000
OED X RETENTION 11) $
A VIOFDOMCOMPEMUnON 52WEGBWM 1101/2014 01101/201 X we araTU
AND pEMPpL{O~YET
~
OFFI E ERpW~LIAARB(LO.~ITY YIN
CElBM B6i T EL EACH ACCIDENT $1,01)(4000
M EXCLUDED N/A
(MandidwY In NH) E.L. DISEASE-EA EMPLOYEE 1000001)
DESCRIp PTONN OF GWERAnONS E.LMSEASE-POUCYUMIT $1,000,000
B Professional DPR9713226 2/30/2013 01101201 $2,000,000 per claim
Liability $4,000,000 annl aggr.
DESCRIpnON OFOPERAIIONS/ LOCAnnxB/VEHICLES (At1NrA ACORD 101, ApemnM RewYb ampule. N non apes b np AI-0
RE: KAI PN 13310-TGM Grant Application.
The General Liability and Automobile Liability policies Include a blanket automatic Additional Insured
endorsement that provides Additional Insured status to the Certificate holder, Oregon, and Re elected
officials, officers, and employees, only when there Is a written contract or written agreement between the
named Insured and the certificate holder that requires such status, and only with regard to work performed
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 East Mein Street ACCORDANCE WRIT THE POLICY PROVISIONS.
Ashland, OR 97520
AUTHOSIMED REPRESENTATIVE
O 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (201 0105) 1 Of 2 The ACORD name and logo are registered marls of ACORD
5312854956/M11500011 MXTJU
DESCRIPTIONS (Continued from Page 1)
on behalf of the named Insured. The General Lalbillty policy contains a special endorsement with Primary
and Noncontributory wording.
e
i
SAGRTA 25.3 (2010/05) 2 012
051288495516111500011
P REC0IKDER Page 1/ 1
~J~ CITY OF
AS H LAN D DATE . , ` '~•'y~PO NUMBER-='
i5
20 E MAIN ST. 6/12/2014 12300
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 013773 SHIP TO: Ashland Public Works
KITTELSON & ASSOCIATES INC (541) 488-5587
ACCOUNTS RECEIVABLE 51 WINBURN WAY
PO BOX 40847 ASHLAND, OR 97520
PORTLAND, OR 97240
FOB Point: Req. No.:
Terms: Net 15 days Dept:
Req. Del. Date: Contact: Mike Faught
Special Inst: confirming? NO
Quantity:,' . < Unit ,
r;ExC:Price~~"..
Prepare and provide a final copy of a 2,500.00
TGM grant application for SiskiVou
Blvd. pedestrain evaluation and
feasiblity studv.
Contract for Personal Services
Beninninq date: 06/03/2014
Completion date: 06/12/2014
BILL To: Account Payable SUBTOTAL 2500.00
TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 2,500.00
ASHLAND, OR 97520
AcoounYNumber - ProjectNUmber _ ;`Amount ~i Account .Number -'C •Project Number Amount
E 260.08.12.00.60410 2,500.00
Authoriz signature //-c VENDOR COPY
FORM #3 )e'
CITY OF
A request fora Purchase Order -ASHLAND
REQUISITION Date of request: 6/9/2014
Required date for delivery: 6/17/2014
Vendor Name Kittplgnn R Aggnriatpg
Address, City, State, Zip 610 SW Alder St Ste 700 Pnrtland OR 97205
Contact Fax Number & Telephone Number Matt Bell - (503) 973-8169
(503) 273-8169
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
® DirectAward Date approved by Council: Contract #
❑ Verbal/Written 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 ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES ❑ Special Procurement Intergovemmental Agreement
$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 until: Date
Description of SERVICES Total Cost
131 Nn F } A.! J:
Prepare and provide a final copy of a TGM grant application for Siskiyou Blvd. pedestrian ' r
$;2,500 00
evaluation and feasibility study.
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
',TOTAL COST" `I
❑ Per attached quotelproposal $ r
Project Number Account Number: 260.08.12.00.604100
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:
IT Director Date Support -Yes/No
By signing this requisition form, l certify that the City's public contracting requirements have been satisfied.
Employee: Department Head: ga¢~„9 1 &1A)11t/
(Equal or greater than $5,600)
Department Manager/Supervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year., (9/ NO
Finance Director- (Equal to org erthan $5,000) Date
Comments:
Form #3 - Requisition