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HomeMy WebLinkAbout2014-318 Contract - Pure Sound Entertainment Contract for GOODS AND SERVICES Small Procurement Less than $5,000 C I T Y OF INDEPENDENT CONTRACTOR: Pure Sound Entertainment I -ASHLAND CONTACT: Hope Caster 20 East Main Street Ashland, Oregon 97520 Telephone: 5411488-6002 ADDRESS: 148 Haskell St. Unit C Central Point, OR 97502 Fax: 5411488-5311 TELEPHONE: 541-944-7043 FAX: 1 BEGINNING DATE: 12-20-2014 COMPLETION DATE: 12.20-2014 COMPENSATION: 5420 GOODS AND SERVICES TO BE PROVIDED: DJ and MC services during First Frost Opening Night at the Ashland Rotary Centennial Ice Rink. In the event of conflicts or discrepancies among Contract Documents, this standard form of the City of Ashland Contract will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with this standard form City of Ashland Contract. NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shalt, provide all goods as specified above and shall at its own risk and expense, perform any work i described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. j 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, it required to be j registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City, 4. Statutory Requirements: ORS 279B.220, 2796.225, 2796.230, 2796.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. ? 5. Indemnification: Contractor agrees to defend, indemnify and save City, Its officers, employees and agents harmless from those losses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this contract by Contractor its employees; or agents. Contractor shall not be held responsible for any losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City. 6. Termination: Ci s Convenience. This contract may be terminated at any time by the City. T Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. 9. Asbestos Abatement License: if required under ORS, 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 11. Use of Recyclable Products; Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 12. Default. The Contractor shall be in default of this agreement if Contractor commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract. 13. Insurance. Contractor shall at its own expense provide the following insurance: a, 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. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PE F LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: b. General Liability insurance with a combined single limit, or the equivalent, of not less than 5300,06GA for each occurrence for Bodily Injury i and property Damage. It shall include contractual liability coverage for the indemnity provided under this contract-. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than S10-3.000 for each accident for Bodily Injury and Property Damage, including coverage for owned. hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. 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. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor, City of hiand: t i3y By SI nature Alt Qpa"t e ~5~2 L'UiGL° Z~ Print !Name Prin Na e Title Date W-9 One copy of a W-9 is to be submitted with the signed contract Purchase Order No. AP ED AS M FORM L/ y/ Ashls Ass A torngy Revised 10-28-14 Page 1 of 2 pa EXI•IISIT A CERTIFICATIONSIREPRESENTATIONS: 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 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) Revised 10-28-14 Page 2 of 2 1 1 a DATE (MMIDD/YYYY) A~ EA CERTIFICATE OF LIABILITY INSURANCE OP ID DR 12/11/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: PHONE Insurance Marketplace, Inc. AIC, No, Ext : (AIC, No): h-MAIL 1998 Skypark Dr Suite 100 ADDRESS: PRODUCER Medford OR 97504 C USTOMERID#: PURES-1 Phone : 5 41- 7 7 9 - 017 7 Fax : FAX 7 7 2 - 8 2 3 5 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: RLI (mail to IAS) Pure Sound Entertainment INSURER B : Hope Caster 148 S. Haskell #C INSURER C : Central Point OR 97502 INSURER D 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 3 0 0 0 0 0 A COMMERCIAL GENERAL LIABILITY BOP1021592 10/26/14 10/26/15 PREMISES(Eaoccurrence) $ 50000 CLAIMS-MADE F~ OCCUR MED EXP (Any one person) $ 5000 X Business Owners X PERSONAL BADVINJURY $ GENERAL AGGREGATE $ 6 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY JE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION W STATU- OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEM E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ PROPERTY 5848 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) add'1 insd per attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE 20 East Main St Ashland OR 97520 R. Scott Weaver, CIC ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Policy-Number: BOP1021592 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): CITY OF ASHLAND 20 EAST MAIN ST ASHLAND OR 97520 Additional Premium: $20.00 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11- Liability is amended as follows: B. With respect to the insurance afforded to these additional insureds the following additional exclusions A. The following is added to Paragraph C. Who Is An apply: Insured: This insurance does not apply to: 3. The person(s) or organization(s) shown in the Schedule is also an additional insured, but only 1. Any "occurrence" that takes place after you cease with respect to liability arising out of the owner- to be a tenant in the premises described in the ship, maintenance or use of that part of the Schedule. premises leased to you and shown in the Schedule. 2. Structural alterations, new construction or demolition operations performed by or for the However: person(s) or organization(s) designated in the Schedule. a. The insurance afforded to such additional insured only applies to the extent permitted by C. With respect to the insurance afforded to these law; and additional insureds, the following is added to Paragraph D. Liability And Medical Expenses b. If coverage provided to the additional insured Limits Of Insurance: is required by a contract or agreement, the insurance afforded to such additional insured If coverage provided to the additional insured is will not be broader than that which you are required by a contract or agreement, the most we will required by the contract or agreement to pay on behalf of the additional insured is the amount provide for such additional insured. of insurance: BP 04 02 0713 © Insurance Services Office, Inc., 2012 Page 1 of 2 Company Copy 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. BP 04 02 0713 © Insurance Services Office, Inc., 2012 Page 2 of 2 Company Copy From: Mike Neilitz Fax: +1 k877) 350-0413 To: Lonny Flora Fax: +1 (541) 488-5314 Page 3 of 4 1211512014 11:22 Renewal auto policy declarations Page 2 of 6 Policy number: 976102 095 Policy effective date: August 18, 2014 Your Allstate agency is Friendly Family Ins (541) 773-2460 Excluded drivers from your policy None Coverage detail for 2005 Toyota Prius Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $250.17 110 Bodily Injury $50,000 each person $100,000 each occurrence 40 Property Damage $100,000 each occurrence Basic Personal Injury Protection $65.84 (Please see the attached Supplement to Policy Declarations for complete coverage, limits and deductible.) Uninsured Motorists Insurance $22.08 16 Bodily Injury $50,000 each person Not applicable $100,000 each accident 40 Property Damage $20,000 each accident As Stated In Policy Auto Collision Insurance Actual cash value $500 $132.74 (Safe Driving Deductible Reward - deductible reduction amount available is $300) Auto Comprehensive Insurance Actual cash value $500 $35.85 Towing and Labor Costs Not purchased* Rental Reimbursement Not purchased* New Car Expanded Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2005 Toyota Prius $506.68 * This coverage can provide you with valuable protection. Talk to your agent about the availability of this coverage and whether it meets your needs. VIN JTDKB20U253029930 Coverage detail for 1979 Ford Truck F250 Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable Suspended Bodily Injury $50,000 each person $100,000 each occurrence Property Damage $100,000 each occurrence Basic Personal Injury Protection Suspended (Please see the attached Supplement to Policy Declarations for complete coverage, limits and deductible.) (continued) N O_ M O o O O < O n f` O N ~ O From Mike Neilitz Fax: +1 k877) 350-0413 To: Lonny Flora Fax: +1 (541) 488-5314 Page 4 of 4 1211512014 11:22 Renewal auto policy declarations Policy number: 976102 095 Cl~)Allstate, Policy effective date: August 18, 2014Your Allstate agency is Friendly Family Ins You're in foad hands. (S41) 773-2460 Page 3 of 6 Coverage Limits Deductible Premium Uninsured Motorists Insurance Suspended 10 Bodily Injury $50,000 each person Not applicable $100,000 each accident 40 Property Damage $20,000 each accident As Stated In Policy Auto Collision Insurance Actual cash value $500 Suspended (Safe Driving Deductible Reward - deductible reduction amount available is $300) 40 Auto Comprehensive Insurance Actual cash value $2,000 $7.05 Towing and Labor Costs Not purchased* Rental Reimbursement Not purchased* New Car Expanded Protection Not purchased* Sound System Not purchased* Tape Not purchased* $7.05 Totalpremium for 1979 Ford Truck F250 * This coverage can provide you with valuable protection. Talk to your agent about the availability of this coverage and whether it meets your needs. VIN 1FTNX21F4XEE74823 - Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together. ■ Oregon Allstate Fire and Casualty Insurance Company Auto ' Amendatory Endorsement-Oregon - AU14223-3 Insurance Policy- AFA18 ■ Claim Satisfaction Guarantee Amendatory Endorsement A P4780-1 0 0 m z 0 0 s 0 Service. Agreement « 2hws agreement is made this 21s' day of ,duly, 2014 6etween 0_7 Mope - Turf Sound Entertainment and Asfiland marks at q greation. (hereinafter referred to as the "CCwent'9 for disc jockey service on November 22"d 2014. fire Sound Entertainment agrees to provide the following services to the CCwent in consideration of the amount specified 6efow. fackag& Q7 eg 5tC Event - Full q)j System Set Z/p lOice of (Package: $400.00 forfcrst 4 hours/$100.00 for each additional hour. A retainer fee of $0.00 wilt hold date and time of event with a 6alance due of $400.00 to 6e paid day of event, and include any additwonafhours. Location andT=w. qhe event wilt 6e hefif at the Location of the Ice ginkinXs(ifand Music Start 7me wift 6e 6•00 pm and wilt continue for a minimum of 4 hours. fire Sound Entertainment wiffaskCCwent for continuation 15 minutes 6efore 4-hour minimum has expired and will foffow after every 1- hour continuation. Pure Sound Entertainment wilt arrive at Least 1 hour(s) 6efore start time. Cancellation ft&y: In the event the services of the 1tre Sound Entertainment are no longer required, the CCwent agrees to pay a percentage of the totafagreed fee as set 6efow: Tor Wture of deposit if the event is canceffed at any time from signing of contract 50% of the totaffee if the event is cancelred within 30 days of the scheduled event 100% of the total fee if the event is cancelled within 7 day of the scheduled event tPure SoundEntertainwnt www.med{orddi.com - dihope@puresounddi.com - Cefl 541-944-7043 -148J&skeQSt Vnit C Central Point OR, 97502 1st Addntl Ins Copy BUSINESSOWNERS BP 12 01 08 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS POLICY CHANGES THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY BOP1021592 112/20/14 RLI Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE HOPE CASTER DBA PURE SOUND ENTERTAINMENT CHANGES • Additional Insured Endorsement form, BP 04 02 , has been added. 12/05/14 Insurance Association Svcs./34688 Insurance Marketplace, Inc./39607 BP 12 01 08 10 © Insurance Services Office, Inc., 2009 Page 1 of 2 POLICY AMOUNT AND PREMIUM ADJUSTMENT Limits of Insurance Premiums Coverage Previous Limit New Limit Previous New ®Add'I Premium Description of Insurance of Insurance Premium Premium ❑Return Premium ADDITIONAL INSURED $20.00 OPTIONAL COVERAGES The following optional coverages are added under this policy when ❑ Add'I. Premium designated by an "X" in the box(es) shown below. ❑ Return Premium Limits of Insurance ❑ Outdoor Signs ❑ Burglary and Robbery (Named Peril Endorsement only) Inside the Premises or ❑ Money and Securities Outside the Premises ❑ Employee Dishonesty Each Occurrance ❑ Equipment Breakdown TOTAL PREMIUM ADJUSTMENTS PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE ADDITIONAL $20 RETURN REMOVAL If Covered Property is removed to a new location that is described on this Policy Change, you may extend this PERMIT insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change: after that, this insurance does not apply at the previous location. Authorized Representative Signature BP 12 01 08 10 © Insurance Services Office, Inc., 2009 Page 1 of 2 Policy Number: BOP1021592 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): CITY OF ASHLAND 20 EAST MAIN ST ASHLAND OR 97520 Additional Premium: $20.00 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Liability is amended as follows: B. With respect to the insurance afforded to these additional insureds the following additional exclusions A. The following is added to Paragraph C. Who Is An apply: Insured: This insurance does not apply to: 3. The person(s) or organization(s) shown in the Schedule is also an additional insured, but only 1. Any "occurrence" that takes place after you cease with respect to liability arising out of the owner- to be a tenant in the premises described in the ship, maintenance or use of that part of the Schedule. premises leased to you and shown in the Schedule. 2. Structural alterations, new construction or demolition operations performed by or for the However: person(s) or organization(s) designated in the Schedule. a. The insurance afforded to such additional insured only applies to the extent permitted by C. With respect to the insurance afforded to these law; and additional insureds, the following is added to Paragraph D. Liability And Medical Expenses b. If coverage provided to the additional insured Limits Of Insurance: is required by a contract or agreement, the insurance afforded to such additional insured If coverage provided to the additional insured is will not be broader than that which you are required by a contract or agreement, the most we will required by the contract or agreement to pay on behalf of the additional insured is the amount provide for such additional insured. of insurance: BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 1 st Add ntl Ins Copy 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 1 st Addntl Ins Copy AJI I i i^~~r(~y~o Page 1 / 1 ASHLAND PARK COMMISSION 20 E MAIN ST. DATE PO NUMBER ASHLAND, OR 97520 12/23/2014 1 F 00421 (541) 488-5300 VENDOR: 004343 SHIP TO: DJ HOPE PURE SOUND ENTERTAINMENT LLC 148 S HASKELL ST UNIT C CENTRAL POINT, OR 97502 FOB Point: Ashland, Oreqon Req. No.: Terms: net Dept.: Req. Del. Date: contact: Rachel Dials - Lonny Flora Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price DJ Service for Special Event 12/20 420.00 First Openinq Niqht at Ashland Ice Rink Contract for Goods and Services Small Procurement less than $5,000 Beqinninq date: 12/20/2014 Completion date: 12/20/2014 SUBTOTAL 420.00 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 420.00 Account Number Project Number Amount Account Number Project Number Amount E 211.12.03.02.60691 E 000007.999 420.00 123 AAuthoriked Signatures I VENDOR COPY FORM #3 -1 CITY OF ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name f6a f 11-f Address, City, State, Zip '14-- G Contact Name & Telephone Number Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Les than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon Direct Award 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 Intergovernmental 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 S e t"i cdf S,~ ~~Q I e ren t Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quote/proposal $ Project Number 000 QQZ - gy j Account Number,,9LL - «-03- Qa'- .6QhQ1 J 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, I certify that the City's public contracting requirements have been satisfied. Employee: - ~l Department Head: ,--I i (Equal to or greater than $5,000) Department Manager/Supervisor:J/1'! I ,Y 'd iJCity Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year YES / NO Finance Director (Equal to orgreaterrhan $5,000) Date Comments: Form #3 - Requisition