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HomeMy WebLinkAbout2015-334 Contract - Accusource Inc Contract for Back round Screening Services CITY OF CONTRACTOR: AccuSource, Inc. ASHLAND CONTACT: Becky Palmer 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1240 E Ontario Ave, Suite #102-140, Corona, Telephone: 541/488-6002 California 92881 Fax: 541/488-5311 TELEPHONE: 888-649-6272 FAX: 888-649-6244 DATE AGREEMENT PREPARED: November 19, 2015 EMAIL: BPalmer@accusource-online.com BEGINNING DATE: November 19, 2015 COMPLETION DATE: December 1, 2017 COMPENSATION: Fee schedule is attached as Exhibit C GOODS AND SERVICES TO BE PROVIDED: Background Screening Services The background screening service provider (also referred to as the "contractor") will be required to provide accurate tracking and reports and resolve open-ended cases or cases involving misinformation to the City's satisfaction. Contractor shall be responsible for the professional quality and technical accuracy of the services furnished by Contractor and without additional compensation will correct or revise errors or deficiencies per accepted criteria and/or requirements. Contractor will ensure their employees are sufficiently trained, qualified and screened to ensure background screening information remains confidential and customer service remains at the highest level. Contractor will agree to hold confidential information in strict confidence. Contractor will provide the City with the results of the background screening services requested within the processing time agreed to by the contractor and the City. Contractor shall notify, v!a postal mail and email, the designated City contact when results are available for review. Contractor shall provide template Adverse Action letters for the City's use that are compliant with Fair Credit Reporting Act (FCRA) requirements educating the applicant on how to receive a free copy of the report used in the determination to take adverse action. SPECIAL PROCUREMENT - Approved b City Council October 20, 2015, Valid until November 1, 2020 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 rims 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. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 27913.220, 2796.225, 27913.230, 2796.235, 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 an subcontractor Contract for Background Screening Services, Revised 06/02/2015, Page 1 of 6 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 part, effective upon delivery of 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 contract in the event of a breach of the contract by the other. Prior to such termination the party sE:eking 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 of 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 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. 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 an material breach or default of Contract for Background Screening Services, Revised 06/02/2015, Page 2 of 6 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 assigr:ment 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 subect workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 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: $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.' 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 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 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. Contract for Background Screening Services, Revised 06/02/2015, Page 3 of 6 Contractor: City of Ashland y By r B Signature 1ature Department Head Print Name Print Name ( 2 c . - Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. AP TD AS TO FORM Ashland st. Clty Attorney Date Contract for Background Screening Services, Revised 06/02/2015, Page 4 of 6 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, undE'r 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 withhc lding 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 se;)arate 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 sepa; ate from the personal residence listing. (4) Labor or services are performed only pursuant o 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 Background Screening Services, Revised 06/02/2015, Page 5 of 6 CITY OF ASHLAND, IOREGON EXHIBIT B City of Ashland LIVING W G rm gills per hour effective June 30, 2015 (Increases annually every June 30 by the Consumer Brice Index) Employees must be paid a portion of business of their 401 K and IRS eligible living wage: employer, if the employerhas cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the projector the employee. ➢ For all hours worked under a business from the City of service contract between their 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 Background Screening Services, Revised 06/02/2015, Page 6 of 6 Background Screening Services PROPOSED FEE SCHEDULE Item Services to be Performed Unit Unit Price 1 Address Profile - Verification Social Security Each S d~ ~3 ~ 51z. Criminal I llstory Search (County- United c' Each States) or (Statewide where applicable) Criminal History Search All new hires 3 are subject Each International / Canada / where applicable) ( to screening ~ -2 ~ 4 Civil History Items 1-6. Each A~ l2 o z 5 Federal Criminal History Each f7 t 6 Registered Nationwide Sex Offender Search Each S _ __.PACKAGE PRICE a7 1 r~., _for items 1-6 if available PACKAGE PRICE - Volume Price Break (for items 1-6, if available} / Driving History in Current Licensed State Each_ C ( State requested ) S - Credit Report (Employment) Screening Each ~q - z Employment Bate Verification: items 7-13_ 9 (Hire date and termination dates only) are Each z considered Requested: 1 _ 2 3 individually Employment Reference Comprehensive with based one 10 narrative: It Requested: 1 _ 2 3 _ what is Each . applicable Education /Academic Verification for a specific l 1 (Degree claimed / Year) employment Each S T cc, J S ,t position. 12 DOT 49: (For Commercial Drivers) Each 13 Health Care Integrity: (OIG/HHS) Each M c - PACKAGE PRICE (for items 7-13, if available) PACKAGE PRICE Volume Price Break for items 7-13 if available PACKAGE PRICE., - Items 1-13, if available Ilk i J, PACKAGE PRICE - Volume Price Break << ( for items 1-13, if available) FLAT FEE r 14 Basic Background Check ~ (Each) Prices will be guaranteed for a minimum of (24) months. 1 `,I ? I rF,~ r 1r-- a-7t j,e~ r' C' t f ~ .~t~. ~ ~ G. y.. rL-(`- G c:_G<~<-5'S f ~ e'_y. -~-•'''t"''~.. d`^.-~V C- .~"`r- ~S e c---~ RFP - Batcks round Screening Serui cs, Page 3 of 3, 1 1 /7/201 r1 ~t~ ~ ~a ACCUS-1 OP ID: RB (MM/DD/YYYY) ~R° CERTIFICATE OF LIABILITY INSURANCE 71T'21/01/2015 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 endorsement(s). PRODUCER NAMEACT Sawyer Cook In_surance_ Sawyer Cook Insurance PHONE 909-435-0230 !FAX No 909-798 7971 1200 California St., Ste 260 WC, No _Ex : No 90 Redlands, 92374 E-MAIL ADDRESS-:--- INSURER(S) Cook ok Insurance - INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: Zurich Insurance Company INSURED AccuSource -INSURER e : Preferred Em_p_loyers Insurance '.10900 Lianne Charton-Holder 1240 E. Ontario Ave #102 - 140 INSURER C: Houston Casualty Company Corona, CA 92881 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. INSR ADDL $UBR~- POLICY EF POLICY EXP LIMITS LTR TYPE OF INSURANCE IN D WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 2,000,000 DAMAGE TO RENTED j CLAIMS-MADE i~~ OCCUR X ! PAS40515489 05/23/2015 05/23/2016 ~_I PREMISES (Ea occurrence $ 2,000,000 10,000 f _MED EXP (Any one person) $ r PERSONAL & ADV INJURY T$ excluded I~ - _GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,~D~e0~0 X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 4,000,000 - D JECT u_j I OTHER: $ AUTOMOBILE LIABILITY [~Eaaccident) OMINED SINGLE LIMIT $ 1,000,000 ANY AUTO ;PAS40515489 05/23/2015 05/23/2016 A BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ _J - - - - NON-OWNED ~ i -PROP ERTYDAMAGE I$ X HIRED AUTOS x X AUTOS Per accident Ded $ 50 UMBRELLA LIAB OCCUR EACH OCCURRENCE I, $ _ EXCESS i i - EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION ! PER 0TH- X ',STATUTE ER AND EMPLOYERS' LIABILITY 1,000,000 B !ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 'WKN11788712 09/01/2015 09/01/2016 EL . EACH ACCIDENT _ $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) ❑ EL DISEASE-- EA EMPLOYEEi $ 1,000,000 If yes, describe under c 1,000;000 DESCRIPTION OF OPERATIONS below E1, DISEASE -POLICY LL .1. C I'Professional Liab H714103351 05/04/2015 105/04/2016 E & O 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per attached form CG20100704. A request has been sent to the carrier to amend the address on the Additional Insured endorsement. It will be forwarded when received. 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. 90 N. Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Sawyer Cook Insurance N © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AC ACCOUNT NUMBER AU Xf BILL POLICY NUMBER ? TG PR(}DUCER NUMBER D I PAS 40515489 ' 17632951 F001205647-001-00001 NONE BRANCH GR GRAND RAPIDS RENEWAL EFF 05/23/2015 E FOREMOST TINSURANCE GROUP PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (CONTINUED) COVERAGE PART(S) AND FORM FORM OR ENDORSEWNT NAME ANf) OR EN©ORSEML-NT NUMBER FORUM OR 01MRSEMENT SUPPL.EMENIAL INFORMATION ADDITIONAL INSURED - OWNERS, LESSEES OR LIABILITY CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION NAME OF ADDITIONAL INSUREDS PERSONS ) OR ORGANIZATION(S) CG2010 0704 NAME 1 CITY OF ASHLAND NAME 2 ADDRESS 1 20 EAST MAIN STREET ADDRESS 2 CITY ASHLAND STATE OR ZIP 97520 LOCATION(S) OF COVERED OPERATIONS 1195 ELLIOT DR. CORONA CA 9288 COMMERCIAL GENERAL LIABILITY 9S5008 E.d. 3-00 MORTGAGEE COPY 05/05/2015 PAGE 7 OF 8 Page 1 / 1 ASHLAND CITY OF DATE PO NUMBER 20 E MAIN ST. 12/11/2015 13289 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 017153 SHIP TO: City of Ashland ACCUSOURCE INC (541) 488-6002 1240 E ONTARIO AVE STE 102-140 20 E MAIN STREET CORONA, CA 92881 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Tina Gray Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price Backqround Screeninq Services 20,000.00 FY 2016 - 2017 (Balance biennium budget) Contract for Backqround Screeninq Services Beqinninq date: November 19, 2015 Completion date: December 1, 2017 i SUBTOTAL 20 000.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 20, 000.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 710.01.49.00.60410 20 000.00 t11' Autho?izedSignature VENDOR COPY FORM#3 CITY OF ~~'l~lr~huise tiler ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name " l y= -"'r=<= Address, City, State, Zip 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 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 ❑ 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 ❑ Fgrm #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES Eg"Special Procurement Intergovern mental Agreement $5,000 to $75,000 Form #g, Request for Approval ❑ Agency E] Less than $35,000, by direct appointment E[' ritten quote or proposal attached Date original contract approved by Council: El (3) Written proposals/written solicitation Date approved by Council: (Date) El Form #4, Personal Services $5K to $75K Valid until: Z/ - Date - (Attach copy of council communication) Description of SERVICES Total Cost ' _ - ~ao tip - M7) Item # Quantity Unit Description of MATERIALS Unit Price Total Cost I ❑ Per attached quotelproposal TOTAL COST $ Project Number Account NumberT0 - Gl - ~~f- Account Number___-__-_ AccountNumber___-_ *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, 1 certify that the City's public contracting requirements have been satisfied. Employee: Department Head: (Egdal to oXgreater than $5,000) Department Manager/Supervisor- WW 1'a'4 City Administrator: gam; , _ (Egdal to or greaterthan $25,000) Funds appropriated for current fiscal year / NO: G-14-1 / z /E/// S- Finance Director- (Equal to orgk4terthan $5,000) Date Comments: Form #3 - Requisition