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HomeMy WebLinkAbout2016-141 Contract - Accustat Sports Timing Contract for GOODS AND SERVICES Small Procurement Less than $5,000 C I T Y Of INDEPENDENT CONTRACTOR: Accustat Sports Timing Inc ,ASHLAND CONTACT: Eric Larpenteur, President 20 East Main Street ADDRESS: 8748 NE Glisan St. Portland, OR 97220 Ashland, Oregon 97520 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (503) 803-9377 FAX: BEGINNING DATE: 5/1/16 COMPLETION DATE: 7/31 COMPENSATION: $2500 for up t0 833 runners for the 2016 4th of July Run. $2.50 per runner after B33. C2,U htt; I; GOODS AND SERVICES TO BE PROVIDED: Database management and chip preparation services for the 41h of July Run 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 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. 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, 27913.225, 279B.230, 279B.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: City's Convenience. This contract may be terminated at any time by the City. 7. 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. 8. 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 PENALTY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: s; b. General Liability insurance with a combined single limit, or the equivalent, of not less than 1,000,00 f urrence for Bodily Injury izI and Property Damage. (It 2UAD_~ c. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $466e 9Ae ore c accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. AIL ~a.- 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 Ashland: ' 7 By By Signa u aDartmienAtHel1.t Nam Print Name P0~I iz 3 O c i _ Title ate W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. Revised 10-28-14 Page 1 of 2 r~ 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. (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. V (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. -2 Contractor (Date) Revised 10-28-14 Page 2 of 2 7 ® DATE (MM/DD/YYYY) A~~ o CERTIFICATE OF LIABILITY INSURANCE 6/21/2016 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 CONTACT NAME: Cindy Cromwell Elliott Powell Baden and Baker Inc. PHONE (503) 227-1771 FAX (503)274-7644 (A/C No Ext)• _ (A/C, No): 1521 S.W. Salmon Street E-MAIL ccromwell@epbb.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Portland OR 97205-1783 INSURERA:Vallev Forge Insurance Co. 20508 INSURED INSURER B : ACCUSTAT SPORTS TIMING INSURER C : 8748 NE GLISAN ST INSURER D : INSURER E : PORTLAND OR 97220 INSURER F : COVERAGES CERTIFICATE NUMBER:16-17 GL 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 AD-DL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 '000 DAMAGE TO RENTED A CLAIMS-MADE El OCCUR PREMISES (Ea occurrence) 300,000 X 5085898531 2/1/2016 2/1/2017 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY_ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ - 2,000,000 POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ _ 2,000,000 X JECT OTHER: Employment Practices Liability $ 10 , 000 AUTOMOBILE LIABILITY Ea aBIEDtSINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS - HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident) - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ - - - - WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY _ Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE L E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? J N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE E--$ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Please see attached SB146932E 06/11 endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Cindy Cromwell/SHELLY ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) PROGRESSIVE PR49 REUME P.O. BOX 31260 TAMPA, FL 33631 D/RZ-OTAuto Policy Number: 71548254 Underwritten by: Progressive Universal Insurance Co ERIC J LARPENTEUR April 15, 2016 8748 NE GLISAN ST Policy Period: Mar 3, 2016 - Sep 3, 2016 PORTLAND, OR 97220 Page i of 3 progressive.com Online Service Make payments, check billing activity, update policy information or check status of a claim. Auto Insurance 1-800-776-4737 For customer service and claims service, Coverage Summary 24 hours a day, 7 days a week, T 1i1s ii ,our Declarations age Your coverage has changed Your coverage began on March 3, 2016 at 12:01 a.m. This policy expires on September 3, 2016 at 12:01 a.m. This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for a vehicle may not be combined with the limits for the same coverage on another vehicle. The policy contract is form 9611 D OR (08/15). The contract is modified by forms 2357 (01/07) and 4884 (10/08). Policy changes effective March 24, 2016 Changes requested on: Mar 28, 2016 Requested by: Progressive Premium change: $44.29 .............policy. Changes: Coverage has been changed on the Drivers and resident relatives Additional information .........................................................I........................................................................................... Eric J Lar..enteur Name cured Outline of coverage 2003 FORD ECONO/CLUB WGN E150 SPORT VAN VIN: 1 FDRE'a i W03N671527 Garaging ZIP Code: 97220 Primary use of the vehicle: Commute Limits Deductible Premium Liability To Others $466 Bodily Injury and Property Damage Liability $500,000 combined single limit each accident Personal Injury Protection $25,000 $0 45 Uninsured/Underinsured /Underinsured Motorist $500,000 combined single limit each accident 35 .......ninsu..r..d e....Motorist...............Property.......Damage.................................. $50.....,.0. 0.. 0....... each...acc.ic-id- ent...... .............$200........................5 U $300 hit & run Comprehensive Actual Cash Value $500 11 Collision Actual Cash Value $500 53 Total premium for 2003 FORD ..............................................................................................................................$615 Form 6489AA OR (03/15) Continued Policy Number: 71548254 Eric 1 Larpenteur Page 2 of 3 1996 FORD ECONO/CLUB WGN E350 CARGO VAN VIN: 1 FBHE31YOTHA31026 Garaging ZIP Code: 97220 Primary use of the vehicle: Pleasure Deductible Premium Limits . . . . $432 Liability To Others Bodily Injury and Property Damage Li abilitY $500,000 combined single limit each accident ...$0...........••.••••.'.....39 . Personal Injury Protection $25,000 .........................................28 Uninsured/Underinsured Motorist $500,000 combined single limit each accident 28 $200 Uninsured Motorist Property Damage $50,000 each accident $300 hit & run $00 9 Cash Value . . ..$513 Comprehensive Actual . Tota. l. . premium . . . . for . 1996 FOR 1976 GMC PICKUP VIN: TCS346Z50109 Garaging ZIP Code: 97220 Primary use of the vehicle: Pleasure Deductible Premium Limits . . . . . . . Liability To Others $.194 Bodily Injury and Property Damage Liability $500,000 combined single limit each accident „0 ...................""...Z 19 Personal Injury Protection $25,000 S Uninsured/Underinsured Motorist $500,000 combined single limit each accident ............30 $200 Uninsured Motorist..Property Damage $50,000 each accident $300 hit & run Comprehensive *Actual Cash Value or Stated Amount .500 165 ................................................................................................................................$433 Total premium for 1976 GMC * In the event of a total loss of this vehicle, the maximum amount payable is the lesser of the actual cash value or the stated amount of $6,000. 2005 MINI COOPER S CONVERTIBLE VIN: WMWRH33485TFS3178 Garaging ZIP Code: 97220 Primary use of the vehicle: Pleasure Deductible Premium Limits . Liability To Others $286 Bodily Injury and Proper Damage Liability $500,000 combined single limit each accident . $0 31 , . Personal Injury Protection $25,000 24 Uninsured/Underinsured Motorist $500,000 combined single limit each accident + $200 5 Uninsured utorlst Property Damage each accident $300 hit& run Comprehensive Actual Cash Value $500 24 Collision .............................................................................78 Actual Cash Value $500 ....................................................................................................................................................................$448 Total premium for 2005 MINI ..............................................................................................................................................$2,009.00 Total 6 month policy premium Premium discounts Policy Paid in Full, Home Owner, Online Quote, Multi-Car, Continuous Insurance: 71548254 Platinum and Paperless Continued Form 6489AA OR (03/15) POLICY NUMBER INSURED NAME AND ADDRESS B 5085898531 ACCUSTAT SPORTS TIMING 8748 NE GLISAN ST PORTLAND, OR 97220 PROPERTY COVERAGE LIMIT OF INSURANCE The following deductible applies unless a separate deductible is shown on the Schedule of Locations and Coverage. Deductible: $500 Business Income and Extra Expense Coverage Business Income and Extra Expense 12 Months Actual Loss Sustained Business Income and Extra Expense - Dependent Properties $10,000 Employee Dishonesty $25,000 Forgery and Alteration $25,000 LIABILITY COVERAGE LIMIT OF INSURANCE Liability and Medical Expense Limit - Each Occurrence $1,000,000 Medical Expense Limit Per Person $10,000 Personal and Advertising Injury $1,000,000 Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Damage To Premises Rented To You $300,000 Employment Practices/Fiduciary Liability Retroactive Date: 02/01/2013 $10,000 EPLI Deductible: $0 Policy Number: 71548254 Eric J Larpenteur Page 3 of 3 Lienholder information Vehicle Lienholder 2005 MINI COOPER S WELLS FARGO DLR SVCS WMWRH33485TF83178 PHOENIX, AZ 85038 Form 6489AA OR (03/15) Accustat Sports Timing, Inc. Service Agreement The following agreement is being offered by and between Accustat Sports Timing, Inc and The City of Ashland, OR For the event known as The Fourth of July Run (Herein after known as "The Event") to be held on July 4, 2016 Accustat Sports Timing, Inc will provide the following services at the rates stated below. Database Management and Chip Preparation Services • If requested by The Event AST can set up online registration through any online registration service. • The Event to provide AST with access to its online registration provider for retrieval of information necessary to prepare the database of participants. • If The Event wishes AST to enter off-line registrations to the online registration site, all mail-in entries and/or in-store entries must be sent to AST in a timely fashion. Once per week is acceptable up until the week of the event, during which greater frequency may be required. AST may perform some collection of entries, in which case The Event will provide AST with access to those collection points. • Label and prepare bib/chip packets for pre-registered participants before the start of Packet Pick-Up. Bibs are to be provided by The Event and delivered to AST no less than 2 weeks prior to the start of Packet Pick-Up/Registration. Late delivery may result in AST not being able to complete preparation of Packet Pick-Up materials and AST will not be held responsible. • AST to provide staff to assist in managing volunteers (to be provided by The Event, estimated number of volunteers based on total estimated participation for event to be determined closer to date of event) for Packet Pick-Up and Day of Race Registration. AST staff member will manage "Assistance/Changes" of pre- registered participants. AST staff member will manage volunteers to set up registration area. • Equipment for registration and packet pickup including tables, tents and chairs are to be provided by The Event. • AST to provide one copy of complete database within 5 business days after event in agreed format. • AST to send one copy of complete database within 2 days after the event in agreed format to the event photographer if requested by the event. Day of Race Registration and Chip Preparation • AST will prepare bib/chip packets for individuals who register day of race. • AST will provide kiosk laptops for registration and issue bib/chip packets to individuals who register Day of Race. Chip Timing Services • AST to provide chip timing services Chronotrack(single use) timing system for both the 2 mile and 10k events. • AST to provide staff to assist in managing volunteers (to be provided by The Event) at the Start Line as needed for timing the event. • AST to provide at least one display clock at finish line ($200.00 per clock value). Additional display clocks may be available if there are multiple events starting at different times. • AST to provide and set-up a computer for announcer or a complete list of registered participants listed numerically by BIB number depending on appropriateness. • AST to provide an accurate Gun Start time for all participants (results to be calculated using Finish time minus Gun Start time in accordance with USATF rules for scoring a road race), and Net Time calculated using Finish time minus Matstart Time. • AST to provide results as accurately and quickly as reasonable based on the variable conditions of weather, accuracy of entry forms and equipment. • AST to post complete results on Chronotrack Live during the event. • AST to send results in electronic format to agreed locations on race day. AST is not responsible when results are actually posted to these websites. • AST to make updates to results in a timely manner as appropriate. • AST to provide one paper copy of results to The Event if requested. • AST to send database in electronic format to event photographer for The Event if requested. • AST to provide results for the awards ceremony following the event. • AST to provide mailing labels of award winners to The Event if requested. Promotional Services • If AST timed the race previously, AST will email past participants about the upcoming event. • AST to list The Event on www.accustatsportstiming.com website with links to details about the event and online registration. Additional Services • AST will make arrangements to have the photographer of your choice take photos at the event if requested by the event. • Order Bib numbers through our preferred provider, Marathon Printing, if requested. Cost of bibs will be billed to The Event. • AST will make available to The Event One 14' inflatable Start/Finish arch, 1000 watt PA system, 3 pop up tents Add Split Points $750 per location As a condition of the proposal The Event will provide the coordination, implementation and accountability of the following: Race Directing & Management Service: The Event is understood to be completely responsible for implementation and coordination of the event and is furthermore responsible for all liabilities associated with the management of the event, financial and otherwise. The Event is understood to be completely responsible for the management and set up of all transition areas, start lines, finish lines, pre-event areas, post event areas, course marshals, police, permits and any and all areas of setup and management of the event not pertaining to the timing equipment and equipment provided by AST. Use of Foundation and/or Event Marks: The Event hereby grants Accustat Sports Timing, Inc., a royalty-free, nonexclusive, non-transferable license to use and display the logos, trademarks and trade names associated with The Event, such use is to be solely limited to the promotion(s) held in conjunction with the event. Assumption of Liability. The Event is understood to retain ownership of the event as the Event Operator and Owner and assumes all financial liabilities associated with the event. The Event will further insure the event against any losses, liabilities and damages to persons and property associated with this event in the amount no less than $1,000,000. Under terms of this agreement The Event is responsible to financially cover (but not limited to): a. Permits/Insurance b. Medical, Police and Fire Services c. Advertising/Entry Form Printing d. Shirts/Giveaways e. Equipment Rental f. Race related cost (Ports-lets, Awards, shirts, equipment rentals, etc.) g. Race Bibs h. Event Budget CT system: $ 2500.00. Minimum Fee Includes Database Management, Chip Preparation Services, Chip Timing Services, Promotional Services and Additional Services as stated above for up to 833 participants. Any registered participant and/or finisher over 833 will be billed at $2.50. Transportation and lodging expenses and all necessary equipment and royalties for achieving this have been included in this quote. Terms: of $500.00 due j must be paid a of 30 days ar to the event with the balance or credit of all fees due 30 days after the event. If the Event uses an AST preferred online registration service the Deposit is waived. If the Event is cancelled with 7 or more days notice, the Event is responsible for the cost of the Chronotrack tags ordered. Late payments for balances outstanding will be assessed a 3% per month finance charge. For AST: Title: For The Event: Title: Date: ASHLAND PARKS AND RECREATION COMMISSION 340 S. PIONEER STREET ASHLAND, OREGON 97520 Michael Buck GC?MMISSIONER S: ~ Director 'dike Gardiner Rick Landt TEL: 541.488.5340 Jinn Lei. FAX: 541.488.5314 Stef~niS ett;naer parksintof~ashla;id.or.us Vanston Shaw MEMORANDUM TO: Dave Kanner Michael Black Dave Lohman Doug McGeary FROM: Rachel Dials, Recreation Superintendent DATE: June 14, 2016 SUBJECT: Contract for Goods and Services Less than $5000-4th of July Run/Accustat Accustat will provide database management and chip preparation services for the 4th of July Run. I am asking that the auto insurance requirement be lowered to $500,000. Please sign the agreements where I have noted and call me at 541-552-2260 if there are any concerns about lowering the requirement for auto insurance to $500,000. The contractor is on-site the day before the event and the day of. Thank you and I apologize for the short turn-around required. Home of Famous Lithia Park Page 1 / 1 ASHLAND PARK COMMISSION 20 E MAIN ST DATE PO NUMBER . ASHLAND, OR 97520 6/27/2016 00570 (541) 488-5300 VENDOR: 004490 SHIP TO: ACCUSTAT SPORTS TIMING INC 8748 NE GLISAN STREET PORTLAND, OR 97220 FOB Point: Ashland, Oreqon Req. No.: Terms: net Dept.: Req. Del. Date: Contact: Rachel Dials Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price DATABASE MANAGEMENT AND CHIP PREP 2,500.00 SERVICES FOR 4TH OF JULY CONTRACT FOR GOODS AND SERVICES LESS THAN $5,000 BEGINNING 05/01/16 COMPLETION 07/31/16 SUBTOTAL 2,500.00 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 2,500.00 Account Number Project Number Amount Account Number Project Number Amount E 211.12.03.02.60695 E 000003.999 2,500.00 VENDOR COSY Autho ed Signature FORM #3 ~sNt 4S6 REGPE?> Date of request: / 7// REQUISITION Required date for delivery: Vendor Name + fS 1 Address, City, State, Zip 7 6L,161~2' I.? L Contact Name & Tel I 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 Less 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 # ❑ Special Procurement Intergovernmental Agreement PERSONAL SERVICES E] Agency $5,000 to $75,000 El Form #9, Request for Approval Date original contract approved by Council: ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached (Date) ❑ (3) Written proposals/written solicitation Date approved by Council: ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost +0 qkcae-d DAAW,., M N lDl PYPSU'0 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost ~ C-'I" qy , ~.1 TOTAL COST ® Per attached quotelproposal Project Number - C~` Lip'") Account Numbers: Account Number Account Number 2 LI_ -1 _ .~A~ .04 - s 4 *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 thi eq 'sition form, I certify that the City's public contracting requirements have been satisfied. Employ e: Department Head: (Equal to or greater than $5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YES / NO Finance Director- (Equal to or greater than $5,000) Date Form #3 - Requisition