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HomeMy WebLinkAbout2015-262 Contract - APEX Business Forms Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Apex Business Forms ASHLAND CONTACT: Mikki Rotter, Office Manager 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1056 Antelope Road, White City, OR 97503 Telephone: 541/488-6002 Fax: 5411488-5311 TELEPHONE: 541-830-5128 DATE AGREEMENT PREPARED: September 9, 2015 FAX: 541-830-7610 BEGINNING DATE: September 9, 2015 COMPLETION DATE: June 30, 2016 COMPENSATION: $3,998.40 (160,000 utility bills @ $24.99/M) per Apex bid attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Utility bills to be printed, stored and delivered per Invitation to Bid attached as Exhibit D and Apex bid attached as Exhibit C. ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and Services 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 the said primary 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 shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 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, if required to be 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. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work 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. Compensation under this contract, including all costs and expenses! of Contractor, is limited to $25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of city. i 6. Statutory Requirements: ORS 279B.220, 2796.225, 27913.230, 27913.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is $20,142.20 or more, Contractor 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 work under this contract. Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor 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 Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract). Contractor 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. 9. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in art, effective upon delivery of Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 1 of 5 written notice to Contractor, 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 Contractor 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 Contractor may terminate this cortract 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 Contractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor 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 df termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor 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 Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. 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. 11. 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. The Contractor understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and Subcontracts: Contractor 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. Contractor shall be fully responsible for the acts or omissions bf 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. 14. 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. 15. 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; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor 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. 16. Insurance. Contractor 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. 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. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, 4M -004" or Not Applicable for each accident for Bodily Injury and Pro a Damage, Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 2 of 5 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 Contractor or its insurer(s) to the City, e. Additional Insured/Certificates of Insurance. Contractor 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 Contractor's services to be provided under this Contract As evidence of the insurance coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work under this contract. The contractor's insurance is primary and non-contributory. 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 Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self- insurance. 17. 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 Taws, 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 Contractor 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. Contractor, 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. 18. 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. CONTRACTOR, 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. 19. 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. Contractor 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 Contractor, with no further liability to Contractor. 20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: City of Ashland By L LJ--I_ L Z,By jj Signature Department Head 0 Print Name Print Name C1 Titl Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. Contract for Goods and Services Less than $25,000, Revised 06/02/2015, 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 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 chocked 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. (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. J-h~ wcd~'d Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 4 of 5 i CITY • ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WAGE per hour effective June 30, 2015 (Increases annually every June 30 by the Consumer Price 'Index) • - . - portion of business of their 401 K and IRS eligible employer, if the employerl has cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by r the employee, For all hours worked under a assistance for the project': service contract between their business from the City of Ashland in excess of ➢ Note: "Employee" does not employer and the City of $20,142.20. include temporary or part-time Ashland if the contract employees hired for less than exceeds $20,142.20 or more. ➢ If their employer is the City of 1040 hours in any twelve- Ashland including the Parks month period. For more ➢ For all hours worked in a and Recreation Department. details on applicability of this month if the employee spends policy, please see Ashland employee's or more of the ➢ In calculating the living wage, Municipal Code Section employee's time in that month employers may add the value 3.12.020. working on a project or of health care, retirement, 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 Goods and Services Less than $25,000, Revised 06/02/2015, page 5 of 5 BUSINESS FORMS 1050 Antelope Rd. White City, Ott 97503 • 541.830.5128 Fax 541.830.7610 9/2/15 City of Ashland Attn: Kariann Olson, Purchasing 90 N. Mountain Ave Ashland, OR 97520 Thank you for the opportunity to bid on the Utility Bills. Apex Business Forms is a well-established business and have provided many printing projects to the City of Ashland. We have been successfully printing the Utility Bills for the City of Ashland since 2005. We are familiar with the paper and delivery procedures and our quality and consistency has been proven. While we are 100% women owned business we haven't established it with the state yet. 160,000 24.99JM on 30% recycled stock - the same stock we have been using for years successfully. Artwork change included in the price. Thank you, Mikki Rotter Office Manager Apex Business Forms mikki@apexbusinessforms.com 1050 Antelope Rd. White. City, OR 97503 • 541.830.5128 . Fax 541.830.7610 K Y CITY OF FORM #2 ASHLAND INVITATION TO BID INTERMEDIATE PROCUREMENT Release date: August 21, 2015 Requested by: Kariann Olson, Purchasing City of Ashland 90 N. Mountain Avenue Ashland, OR 97520 Tel: 541 488-5254 Fax: 541488-5320 Email: kari.olson@ashland.or.us Bids are due by: 1:00 PM (PST), Thursday, August 27,201-5 Project name: UTILITY BILLS (Printing, Storage and Delivery) Bids may be faxed, emailed or hand delivered. Contractors shall submit bid on their company letterhead. Informal email bids and/or late bids will not be accepted. The successful contractor will be required to enter into a contract with the City for the services and provide insurance certificates in their own name for General Liability, Automobile and Workers' Compensation. Workers' Compensation insurance is mandatory. Subcontracting will not be permitted. SCOPE OF GOODS AND SERVICES Artwork: Replace AFN logo with "'new" logo located above the telephone number (541-552-2222) on front bottom right corner of utility bill, and provide proof to City for approval prior to printing. Printina: Print 160,000 utility bills, 4-1/2 X 14, Blue PMS 283, Needs to be brighter/clearer on back for ease in reading fine print. (An original copy of a utility bill will be provided to successful bidder as an example of the blue color and shading.) Storage and weekly deliveries: Provide storage for 160,000 utility bills. Deliver 2 cases (minimum 4,500) per week (any day of the week) to the Utility Billing office located downstairs City Hall at 20. E. Main Street, in preparation for the next week's billing. This service is mandatory and must be Quaranteed for one year and/or until the entire order has been delivered in this manner. Please provide an official bid on your company letterhead, including the following information: 1. Provide contact information for your company, including but not limited to: company name; contact name(s); physical address of company; telephone number(s); fax number, and email address(s) for contact personnel 2. Provide firm price for required change to Artwork (replace AFN logo) 3. Provide firm price for printing 160,000 utility bills (if printing on full rolls of paper, include quantity if different than 160,000) 4. Provide recycled content of paper being used to print utility bills (Prefer a minimum 30% post consumer Form tit - Intermediate Procurement, Invitation to Bid, Trade Services. Page I of 2, 8/21P-015 5. Are you able to provide a sample of the paper to ensure it will run smoothly in the City's printer 6. Provide firm price for storabe and delivery of utility bills (per scope of services outlined above) 7. Provide copies of insurance certificates for the insurance your company consistently maintains that is relative to the services being requested, including but not limited to: general liability, automobile, Workers' Compensation, etc. (Please note that the contract terms will require the successful bidder to provide insurance certificates in their own name, including the City of Ashland endorsed as the additional insured.) If you have any questions and/or need additional information, you are welcome and encouraged to contact Kariann at 541-488-5354. Due date and time for submitting quotes is 1:00 PM (PST), Thursday; August 27, 2015. Late quotes will not be considered. Thank you. Method of Award. ORS 279B. 070 Intermediate Procurements. (4) I fa contract is awarded, the contracting agency shall award the contract to the offeror whose quote or proposal will best serve the interests of the contracting agency, taking into account price as well as considerations including, but not limited to, experience., expertise, product functionality, suitability for a particular purpose and contractor responsibility under ORS 279B.110. ITB - Utility Bills, Page 2 of 2, August 21, 2015 ) ® DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE F9/9/2015 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 endorsements . NTA PRODUCER NAME: Sheryl TVIrts Protectors Insurance, LLC PHONE o xt : 1)842-2968 a No : 41 772-1 906 P.O. Box 4669 E-MAIL Medford OR 97504 ADDRESS:sh Iw protectors in m INSURERS AFFORDING COVERAGE NAIC # INSURER A Travelers INSURED ABFBU-1 INSURER B : ABF Business Forms LLC INSURER C : DBA Apex Business Forms INSURER D : PO Box 1306 Medford OR 97501 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 257095040 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A DL UB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SR WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY N N 680-3E841318-1542 3/19/2015 3/19/2016 EACH OCCURRENCE $1,000,000 DAMAGE T RENTE X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS-MADE ~ OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY N BA-3E842167-15 3/19/2015 3/19/2016 Ea accident $1,000,000 ANY AUTO BODILY INJURY (Per person) $ AUTOS BODILY INJURY (Per accident) $ ALL OWNED X AUTOS SCHEDULED X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS accident) $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION BA-3E842167-15 3/19/2015 3/19/2016 WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS YIN E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE F N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION 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 E. Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Page 1 / 1 CITY OF _ ASHLAND DATE PO NUMBER 20 E MAIN ST. 9/9/2015 13107 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 000157 SHIP TO: City of Ashland-Warehouse APEX BUSINESS FORMS, INC (541) 488-5354 PO BOX 1306 90 N MOUNTAIN MEDFORD, OR 97501 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: Net 30 days Dept.: Req. Del. Date: Contact: OLSON, KARI Special Inst: Confirming? No I Quantity Unit Description Unit Price Ext. Price 160.00 M Utility Bills, 160,000 a $24.99/M 24.99000 3,998.40 Utility bills to be printed, stored and delivered as needed per the Invitation to Bid. Contract for Goods and Services Beqinninq date: September 9, 2015 Completion date: June 30, 2016 SUBTOTAL 3,998.40 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 3,998.40 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 710.03.07.00.60110 3,998.40 Auth ze gnaturre VENDOR COPY FORM #3 CITY OF l~~Qlet"~ ~t1:.LAWC~°ISrdh ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name Address, City, State, Zip Contact Name & Telephone Number Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emernency ❑ 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 Attach co of council communication If council approval required, attach co of CC ❑ Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ VerballWritten quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington Intermediate Procurement t' ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) El Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ® (3) Written quotes and sdicita)8attached ❑ Form #4, Personal Services $5K to $75K Contract # Intergovernmental Agreement PERSONAL SERVICES El Special Procurement L=~' $5,000 to $75,000 i ❑ Agency ❑ Form #9, Request for Approval ❑ Less than $35,000, by direct appointment El Written quote or proposal attached Date original contract approved by Council: El (3) Written proposals/written solicitation Date approved by Council: Date _ (Attach copy of council communication) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost Item # Quantity Unit Description of MATERIALS Unit Price !rTotal Cost TOTAL COST ❑ Per attached quote/proposal s/ eF ProjectNumber______-/~' Account Number - 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 departmen",, approve all hardware and software purchases: IT Director Date Support -Yes/ No By signing this requisit'on~form, Ice fify a the City's public contracting requirements have been satisfied. Employee: epartment Head: ,r (Equal to or great than $5,000) Department Manager/Supervisor: AliY( I+ ` ~'"-City Administrator: ' (Equal to or greater than $25,000) Funds appropriated for current fiscal year: ES NO ,vim V//. Finance Director- (Equal to or greeter than $5,000) Date Comments: Form #3 - Requisition