HomeMy WebLinkAbout2016-173 Contract - JM Construction Inc
Contract for GOODS AND SERVICES UG Prima Upgrade for 85 Winburn Way
CITY OF CONTRACTOR: JM Construction Inc.
-A5 H LAND CONTACT: Jason Myers
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 1637, Shady Cove, OR 97539
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541 878-7810
DATE AGREEMENT PREPARED: 06/20/16 FAX: 541 878-7811, jmconstructioninc@earthlink.net
BEGINNING DATE: 06/20/16 COMPLETION DATE: 09/16/16
COMPENSATION: $16,940.00 per Original Option on Exhibit C
GOODS AND SERVICES TO BE PROVIDED: Underground Primary Upgrade on Winburn Way, Ashland, OR.
City of Ashland Electrical Service Requirement specifications. Install underground primary/communication,
control vehicle traffic and pedestrian, temporary fencing and include all necessary materials. (per Exhibit C &
D)
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.
6. Statutory Requirements: ORS 27913.220, 27913.225, 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 $20,283.20 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 an time b mutual consent of both parties.
Contract for Goods and Services Less than $25,000, Page 1 of 5
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 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 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 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
for Goods and Services Less than $25,000, Page 2 of 5
Damage.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $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, excluding Workers'
Compensation, 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. Nona ppropriations 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 By
ature Department Head
Print ame Print Name
Q~ es~
Title Date
W-9 One copy of a W-9 is to be submitted with APPROVED AS TO FORN,,
the signed contract. Purchase Order No.
nd Asst. City Attorney
Contract for Goods and Services Less than $25,000, Page 3 of 5 pat
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
V/ 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.
ab~4n~tractor (Date)
Contract for Goods and Services Less than $25,000, Page 4 of 5
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING -
WAGE
=per hour effective June 30, 2016
(Increases annually every June 30 by the
~r Consumer Price Index)
portion of business of their 401 K and IRS eligible
employer, if the employer has cafeteria plans (including
ten or more employees, and childcare) benefits to the
has received financial amount of wages received by
assistance for the project or 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 $20,283.20. include temporary or part-time
Ashland if the contract employees hired for less than
exceeds $20,283.20 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
50% 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, Page 5 of 5
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JM0002C OP ID: LS
(MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE DATE
.1012912015
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(les) 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),
l
PRODUCER NAME: Linda Shaddon
United Risk Solutions, inc. PHONE
PO Box 936 A/c No Ext : 541-245-1111 (FAJC No): 541-245-1112
Medford, OR 97501-0067 ADDRESS: linda.shaddon unitedrIsk.com
INSURERS AFFORDING COVERAGE NAIC i
INSURER A : Western National Assurance Co 24465
INSURED JM ConstrUCtiOn, Inc. INSURER B
PO Box 1637
Shady Cove, OR 97539 INSURER C :
INSURER D:
a
INSURER E 7
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.
ADDLSUBR POLICY
ywn POLICYNUMBER MJDDf EYY I EYY LIMITS
I TR TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE S 1,000,
DAMAGE TO RENTED
A X COMMERCIAL GENERAL LIABILITY X CPP108011302 0911512015 0911512016 PREMISES Ea occurrence S 00,(KX
CLAIMS-MADE D OCCUR MED EXP (Any one person) S
PERSONAL & ADV INJURY S 1,000,
GENERAL AGGREGATE $ 2,000,
GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG S 2,000,
X POLICY PRO LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE L[MIT
Ea accident) S 1 pwp
A ANY AUTO X CPP107975002 09115/2015 0911512016 BODILY INJURY (Per person) S
ALL OWNED SCHEDULED BODILY INJURY (Per accident) S
AUTOS X AUTOS
NON- PROPERTY D AGE
UTOS OWNED PER ACCIDENT S
X HIREDAUTOS X A
S
X UMBRELLA LIAS X OCCUR EACH OCCURRENCE S
1,000,
A EXCESS LIAR CLAIMS-MADE X UMB101331602 0911512015 0911512016 AGGREGATE $
I DED X RETENTIONS 10,000 $
WORKERS COMPENSATION WC STATU- '
31 1 EMPLOYERS' LIABILITY (T
AND
E.L. EACH ACCIDENT $
ANY PROPRIETORIPARTNERIEXECUT(VE YIN
NIA
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE -EA EMPLOYE S
ggs, describe under
CRIPT(ON OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required)
EtE: Chautauqua Walkway Project - City of Ashland, its elected officials,
officers and employees are Additional Insured as provided by Endt. WNGL52
01/09. Coverage is primary and non-contributory as provided by Endt. WNGL52
01/09.
CERTIFICATE HOLDER CANCELLATION
CITAS01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WTH THE POLICY PROVISIONS.
90 N. Mountain Ave.
Ashland, OR 97520-2014 AUTHORIZED REPRESENTATIVE
r
T118-0010 ACORD CORPORATION. All rig hts reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
4
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COMMERCIAL GENERAL UABiLITY
}
WN GL 52 01 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OREGON ADDITIONAL. INSURED OWNERS,
LESSEES OR CONTRACTORS AUTOMATIC STATUS
WHEN REQUIRED IN- CONSTRUCTION
AGREEMENT WITH YOU
PRIMARY AND NONCONTRIBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section If - Who Is.-Are Insured is amended to in- a. The preparing, approving, or falling to pre-
clude-as an additional-insured any person or organ- pare or approve, maps. shop drawings. opin-
ization for whom you are performing operations ions, reports, surveys, geld orders, change
when you and such person or organization have orders or drawings and specifications; or
agreed in writing in a contract or agreement that
such person or organization be added as an addi- b. Supervisory, inspection, architectural or en-
tional insured on your policy. Such person or organ- gineering activities.
ization is an -additional insured only with respect to 2. "Bodily injury" or "property damage" occurring
liability for "bodily injury", "property damage" or after.
"personal and advertising injury" caused by-.your a. All work, including-materials, parts or equip=
ongoing operations for the additional insured and ment furnished in connection with such
onlyto-the.'extent that such. "bodily- injury", "property
damage" or "personal 'and advertising. injury" is work, on the project. (other than -service,
caused by your negligence or -the negligence of maintenance or repairs to be performed by
those performing operations. on your behalf. or on behalf of the. additional insured(s) at
the location of the Covered operations has
A person's or organization's status as an additional been completed: -or
insured under this endorsement ends when your
operations for that additional insured are cony b. That portion of "your work" out of which the
leted. injury or damage arises has been put.-to its
p intended use by any person or organization
B. The Limits of Insurance applicable to the additional other than another contractor or subcohtrac-
insured are those specified in the written contract for engaged in performing operations -for a
or' written agreement-or in the Declarations of this principal as a part of the same -project.
policy, whichever is less, These Limits of .trisur- D. As respects the coverage provided under this en-
ance are inclusive of, and not in addition to Limits
of insurance shown in the Declarations. dorsement, Paragraph 4,b. of the other Insurance
Condition is deleted and replaced by the following.-
C. With respect to the insurance afforded to thew- ad-
4. Other Insurance
ditional insureds, the following additional exclusions
app.Iy: b. Excess Insurance
This. insurance does-not apply to: This insurance is excess over any other in-
1. "Bodily injury", "property damage" :or. "personal surance naming the-additional insured as an
and advertising injury" arising out:of the.-re.-rider- insured whether primary, excess, contingent
ing of, or the failure -to render, any professional or on any other basis. unless the written con-
architectural, engineering or surveying services, tract or agreement described in A. above
specifically fequires that this insurance be
including: provided on -either, a primary basis or a pri-
mary and noncontributory basis.
WN GL 52 01 09 includes copyrighted materiai of insurance Services Office Inc. with its pemt lion Page 1 of 1
i
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:Z STATE OF OREGON
° STATUTORY PUBLIC WORKS BOND
Surety bond 665456C CCB # (if applicable): 162365
3
We, JM Construction Inc , as principal, and
Developers Surety and Indemnity Company a corporation qualified and authorized to do
business in the State of Oregon, as surety, are held and firmly bound unto the State of Oregon for the use and benefit of the Oregon
Bureau of Labor and Industries (BOL1) in the sum of thirty thousand dollars (530,000) lawful money of the United States of America
to be paid as provided in ORS chapter 279C, as amended by Oregon Laws 2005, chapter 360, for which payment well and truly to be
made, we bind ourselves, our heirs, personal representatives, successors and assigns, jointly and severally, Firmly by this agreement.
WHEREAS, the above-named principal wishes to be eligible to work on public works project(s) subject to the provisions of ORS
chapter 279C, as amended by Oregon Laws 2.005, chapter 360, and is, therefore, required to obtain and file a statutory public works
bond in the penal sum of 530,000 with good and sufficient surety as required pursuant to the provisions of section 2, chapter 360,
Oregon Laws 2005, conditioned as herein set forth.
NOW, THEREFORE, the conditions of the foregoing obligations are that if said principal with regard to all work done by the
principal as a contractor or. subcontractor on public works project(s), shall pay all claims ordered by BOLI against the principal to
workers performing labor upon public works projects for unpaid wages determined to be due, in accordance with ORS chapter 279C,
as amended by Oregon Laws 2005, chapter 360, and OAR Chapter 839, then this obligation shall be void; otherwise to remain in full
force and effect.
This bond is for the exclusive purpose of payment of wage claims ordered by BOLI to workers performing labor upon public works
projects in accordance with ORS chapter 2790, as amended by Oregon Laws 2005, chapter 360.
This bond shall be one continuing obligation, and the liability of t11e surety for the aggregate of any and all claims which may arise
hereunder shall in no event exceed the amount of the penalty of this bond.
This bond shalt become effective on the date it is executed by both tine principal and surety and shall continuously remain in effect
until depleted by clainis paid udder OILS chapter 2790, as amended by Oregon Laws 2005, cliapter 360, unless the surety sooner
cancels the bond. This bond may be cancelled by the surety and the surety be relieved of further liability for work performed on
contracts entered after cancellation by giving 30 days' written notice to the principal, the Construction Contractors Board, and BOLL.
Cancellation shall not limit the responsibility of the surety for the payment of claims ordered by BOLT relating to work performed
during the work period of a contract entered into before cancellation of this bond.
IN WITNESS WHEREOF, the principal and surety execute this agreement. The surety fully authorizes its representatives in the State
of Oregon to enter into this obligation.
SIGNED, SEALED AND DATED this 22ND day of August , 20 14
Surety by: Principal by:
Developers Surety andIndemnity Company (Seal) JM Construction Inc
Company, Xame Name
S g r e Lois Weathers Signature
Attorney-in-Fact
Title (e.g -Attorney-in-Fact) Utie
17771 Cowan, Suite 100 P 0 Box 1637
Address Address
Irving California 92614 Shady Cove, OR 97539
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PROPOSAL & CONTRACT
Date: June 3, 2016
Proposal Submitted To: Dave Tygerson
City of Ashland - Electric Department
90 North Mountain Avenue
Ashland, Oregon 97520
Phone: (541) 552-2389 Fax: (541) 552-2436
Email: tygersod@ashland.or.us
PROJECT SITE: Primary Underground Relocation
85 Winburn Way, Ashland
REFERENCE DOCUMENTS: City of Ashland Electrical Service Requirement
Specifications. Ashland Electric Plan Sheet for project printed on May 9, 2016. City of Ashland
Invitation to Bid Sheet dated May 19, 2016. Pre-Bid Meeting on May 19, 2016.
WE PROPOSE hereby to furnish labor & materials as detailed below for the lump sum cost of:
SIXTEEN THOUSAND, NINE HUNDRED FORTY DOLLARS - $16,940.00
1. Install underground primary/communication/infrastructure in accordance with
reference documents listed above.
2. Vehicle Traffic and Pedestrian Control
3. Delivery and Placement of Sand
4. Red Slurry One Sack
5. Concrete Walkway
6. Asphalt Patch
7. Saw Cutting
8. Temporary Fencing
Required Project Completion Date: August 12, 2016
* * THIS PROJECT IS NOT BID AT PREVAILING WAGE RATES
EXCLUSIONS: Engineering and Soil Testing Permits and Fees
Surveys and Locates Topsoil
Landscaping and Irrigation Vaults and PVC Conduits
Couplings/ including Fiberglass/PVC
Radius Sweeps
Proposal - City of Ashland Elect- 85 Winburn 1 of 3 June 3, 2016
z P.O. Box 1637
Shady Cove, Oregon 97539
c (541) 878-7810 Fax: (541) 878-7811
A
0 Email: _imconstructionincCuearthlink.net
ccb# 162365
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A
PAYMENT TERMS: Progress invoices will be supplied by JM Construction Inc. at the end of
each month and shall be paid by the customer no later than the 10th of the subsequent month.
Any amounts and/or balances in arrears more than thirty (30) days will be subject to 1.5% per
month interest or as allowed by law.
DISCLOSURES: All material is guaranteed to be as specified. All work to be completed in a
workmanlike manner according to standard practices. Any alteration or deviation from above
specifications involving extra costs will be executed only upon written orders, and will become
an extra charge over and above the estimate. However, JM Construction Inc. shall not be
deemed to have waived its right to compensation for extra work if the extra work was not
provided for in writing, but shall be paid the reasonable value for such work performed. All
agreements contingent upon strikes, accidents or delays are beyond our control. Any dispute or
controversy arising out of the terms, conditions, or requirements of this agreement which exceed
$4,000.00 in possible damages shall be submitted to arbitration in accordance with the American
Arbitration Association Construction Industry Arbitration Rules and judgment rendered by the
arbitrator shall be entered into any court of competent jurisdiction. The prevailing party in any
suit or action or arbitration or administrative proceeding (including Construction Contractors
Board Claims) brought under the terms of this agreement to enforce or interpret any provision
herein, shall be awarded attorneys fees and costs as may be adjudged reasonable by the
Arbitration panel, administrative authority, court, or appellate court. Owner to carry fire,
earthquake and other necessary insurance. Our workers are fully covered by Workman's
Compensation Insurance.
Differing Site Conditions: Any undisclosed or unforeseen subsurface conditions that arise upon
excavation that are not deemed "standard" shall be considered above the contract price and shall
be converted to time and material for all extra conditions. (e.g. any soils unable to be excavated
with a typical backhoe, excavator, etc.)
Linear and/or Square Footage Totals: Actual quantities shall be verified between the customer
and a JM Construction Inc. representative upon project completion if necessary.
JM Construction Inc.'s Right to Photograph the Work: Customer shall permit JM Construction
Inc. or person(s) employed or engaged by JM Construction Inc., without compensation or
consideration to the Customer, to take photographs at the project site of both completed work
and work in progress, for purposes including, but not limited to, publication in newspapers,
magazines, and other print media, use in broadcast media, publication via the Internet, and use in
marketing materials used by JM Construction Inc. Such photographs and any accompanying
descriptions shall not identify Customer or the property address of the project without the
express written consent of Customer.
WARRANTY: Warranty and/or guarantee period shall be the standard one (1) year from the
date of substantial completion of this project. This warranty is valid only when the property or
its improvements are subject to normal use and care by the Customer and provided the Customer
has fully complied with all the terms and payment provisions of this agreement. JM
Construction Inc. reserves the right to repair, replace, or pay reasonable sum in order to affect
Proposal - City of Ashland Elect- 85 Winburn 2 of 3 June 3, 2016
M o "o P.O. Box 1637
z
N Shady Cove, Oregon 97539
(541) 878-7810 Fax: (541) 878-7811
-ni Email: imconstructioninc(~eartlilinl;. net
ccb# 162365
Z
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n
any mutual acknowledged repairs or corrections both during the construction process and
throughout the warrantee period.
Note: This proposal may be withdrawn by us if not accepted within thirty (30) days.
JM Construction Inc. /Authorized Signature
ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are
satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment
will be made as outlined above.
Date of Acceptance 12016
Customer /Signature
Customer /Print Name and Title
Proposal - City of Ashland Elect- 85 Winburn 3 of 3 June 3, 2016
74
85 1WINBURN WY NOTES
n ,
Proj: 000 510.999
~ o cnn~ VAULT 644-TRANS-ASH &
All PVC material to be provided
0 by City of Ashland Elec Dept.
N 0 15 30 45 60 75 FT
0 ,
i
9 remove conductor & riser
I 0 ~@ project completion
H5091.604
Option #2: Intercept
4
~ - ~ existing conduit.
i_ - Convert T-5091603
_ i
to Sec. Ped. 59
' ~
~L~5O1603 Splice pit
73 tM1 I
J conduit to be 1 i - ; i
f sized at time of ! 1
remove prdject: depth 36" I
service f - I
=X I
Q T509~16~32
A
CM i ,Option #1: Install New
3" PVC 410 AL @ 36" - E5091631 V.A;
Fu
ture 3 PVC Reroute Service to
to be provided new location i
85 by developer
won-
I --H5091-&30 1 =
- ®-w woo c_ - - 170 ft (1) 4" PVC @ 36" Depth
r INSTALL: 170 ft (1) 3" PVC - Spare Elec
T5091637 170 ft (1) 2 PVC -AFN Future
was woo a 644-TRANS-ASH *Dyed Red Slurry to top of trench
%yV I B U 25 KVA 120/240
Aphase
p P
s
v ~
m -
VAULT DETAIL
s 'd A f 5
- RED SLURRY
36 IN 1 ~
12 IN SAND r
00
12 IN
Print Date. 51912016
644-TRANS-ASHLAND
TOP
SINGLE PHASE TRANSFORMER" Dia. Insert
No. 64-TRANS-2436NS-1626-OFFSET (Shown) (2 Places in Top)
PCORP #7992977 ZG 506 7-7-10 Full 180' Open
1,850 lbs. Galvanized Non Slip Door
w/Locking Latch
i
i
16" x 26" Blockout
w/3'-0" Long Plastic Board
4 (2) - 2-Ton Lift Anchors
> Galvanized Pull/Lift Iron
(1 Each Corner)
`b
2'-0" Long Galvanized "C" Channel
(2 Each Side, 1 Each End)
5'-6° 4'-0"
BASE (4) - Dia. Grounding Inserts
No. 644-8 0 (2 Inside Walls, 2 Outside Walls)
0 3'-6"
3,600 lbs.
3.5" Dia. Term-A-Duct
(8 Each Wall, 2 Walls) 3'-6"
3'-2"
0
2.38" Dia. Term-A-Duct Q
(2 Each Wall, 2 Walls) p a -3.5" Dia. Term-A-Duct
(6 Each Wall, 2 Walls)
4.5" Dia. Term-A-Duct
(2 Each Wall, 2 Walls) 8" Dia. 4.5" Dia. Term-A-Duct
6'-0" Sump \ (2 Each Wall, 2 Walls)
4'-0" 2.38" Dia. Term-A-Duct
(5 Each Wall, 2 Walls)
OPTIONAL TOPS
16" x 26" Blockout
w/2" x 4" x 36" Plastic Board
-2'
T Y1- :G.i.
4 -8"
SINGLE PHASE TRANSFORMER
No. 64-TRANS-2436NS-1626-Center
1,850 lbs.
Scale: 318" = 1'-0"
644-TRANS-ASHLAND 644-TRANS-ASHLAND
Oldcastle PrecastG 3 x 5
File Name: 644-TRANS-ASHLAND
PO Box 323, Wilsonville, Oregon 97070-0323 Issue Date: 2012 CITY OF ASHLAND
Tel: (503) 682-2844 Fax: (503) 682-2657 old castleprecast.com/wilsonviIle
644-TRANS-ASH LAND
6 -
' "
-8
2,_2„ _
1,-10„ 1'-2„
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N I:: I II n
I II
II
I II
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I JJ. II
N II N
CID +
3.5" Dia. Term-A-Duct
(2"x4%36" Plastic Lumber (6 Each Wall, 2 Walls)
2436NS Galvanized NonSli Door (4) Dia. Grounding Inserts
p (2 Inside Walls, 2 Outside Walls)
w/Locking Latch
2.38" Dia. Term-A-Duct
PLAN VIEW (5 Each Wall, 2 Walls)
2'-0" Long Galvanized
No. 644-2436NS-1626 Offset "C" Channel
(1 Each End 2 Each Side)
4.5" Dia. Term-A-Duct
3.5" Dia. Term-A-Duct (2 Each Wall, 2 Walls)
(8 Each Wall, 2 Walls)
2.38" Dia. Term-A-Duct Butyl Resin Sealant
(2 Each Wall, 2 Walls)
8" Dia. Sump
I
Q I I
~ ~ I I
II II I
II II !I II _ I
D, II II II II 0 II II
c~1 III II (-D I I II II ® I
III II I' I
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Hill 1111
- ~ ~ oll II II Ilo ~ ~ - ~ I II II II ~ I
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6" 2'-4" 6"
y 6„ 6' 10„
10"
/Galvanized Pull/Lift Iron
(1 Each Corner)
SECTION AA END VIEW
Scale: 1/2" =-V-0"
Oldcastle Precast 644-TRANS-ASHLAND 644-TRANS-ASHLAND File Name: 644-TRANS-ASHLAND 3 x 5
PO Box 323, Wilsonville, Oregon 97070-0323 Issue Date: 2012 CITY OF ASHLAND
Tel: (503) 682-2844 Fax: (503) 682-2657 oldcastleprecast.com/wilsonville
. CITY
F® #2
INVITATION TO BID - Primary Underground Relocation
Release date: 5/19/2016
Requested by: DAVID TYGERSON / ELECTRIC / Phone 541.552.2389 / Fax 541.552.2436 / Email davet@ashland.or.us
Bids are due by: 3:OOPM Wednesday June 8t'' 2016
Project name: Primary Underground Relocation
Job site location: 85 Winbum Way
Project completion required by: August 12, 2016
Preferred method of shipment for materials/equipment: N / A
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. Terms or discounts which are conditioned upon payment within a certain time
will not be considered for purposes of comparison of bids.
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.
"OR EQUAL": Any brand name listed in the specifications as "or equal" or "or equivalent" shall establish the minimum requirements for quality, utility,
durability, function, purpose, etc. Other product brands may be offered that are equal to or better than the product brand name. Bidder may show cost
difference, alternates and options in the space provided in the quote. This clause is not meant to be restrictive, but to set the minimum standard. THE CITY
SHALL DETERMINE, IN ITS SOLE DISCRETION, WHETHER A PRODUCT OFFERED IS "EQUAL." When the designation is "or equal" or
"equivalent" City shall make its decision after Bid Closing.
SCOPE OF SERVICES
PLEASE SEE ATTACHED CONSTRUCTION DOCUMENTS AND INSTALLATION REQUIREMENTS TO INSTALL:
UNDERGROUND PRIMARY / COMMUNICATION / INFRASTRUCTURE AS PER ATTACHED ELECTRICAL LAYOUT PLAN AND COA ELECTRIC
SERVICE REQUIREMENTS.
PROJECT INCLUDES RESTORATION OF ALL PUBLIC & PRIVATE PROPERTIES AFFECTED DURING PROJECT.
ALL REQUIRED PEDESTRIAN / VEHICLE TRAFFIC CONTROL WILL BE TEE RESPONSIBILITY OF THE CONTRACTOR.
COA IS RESPONSIBLE FOR STATE / CITY PERMITS THAT MAY BE REQUIRED FOR THIS PROJECT.
MATERIAL TO BE PROVIDED BY COA FOR PROJECT WILL INCLUDE: PVC CONDUIT, NEEDED MISCELLANEOUS COUPLINGS I INCLUDING
FIBERGLASS / PVC RADIUS SWEEPS, (1) VAULT AS CALLED OUT IN ELECTRICAL DRAWING.
SPECIAL NOTE: AREA WILL NEED TO BE SECURED FOR HEAVY PEDESTRIAN TRAFFIC DURING PROJECT.
MANDATORY PROJECT WALK IS SCHEDULED FOR: MAY 19, 2016 8:OOAM on site.
All Pricing Must Be Held Firm For 30 Days
Method of Award: ORS 279B. 070 Intermediate Procurements. (4) If a 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.
Form #2 - Intermediate Procurement, Invitation to Bid, Trade Services, Page 1 of 1, 5/11/2016
Excavate
1796 Thomas Rd
Medford, OR 97501
Plane (541) 941-1329
To ester @lat a° oeo
CCB# 142905
Bid
Project: Primary Undergro-Lmd Relocation
Location: 85 Winburn Way
Dig and install 170 ft 4", 3", and 2" pvc with 12" of sand and 2' of red slurry
170' trench @ $100.00/ft $17,000.00
Dig and Install Vault LS $500.00
Cut Erid replace sidewalk LS $2,000.00
Sawcut and patch trend 1..S $2,500.00
Total $229000.00
Thaok .j
May Rock & Excavating, LLC ESTIMATE
CCB#65636 USDOT#0741939
PO Box 319 DATE ESTIMATE NO.
Talent OR 97540
61312016 591
NAME/ADDRESS
City of Ashland Electric Department
Attn: Dave Tigerson We now accept
90 N. Mountain Street MasterCard, Visa &
Ashland OR 97520 Discover Card.
PROJECT
85 Winburn Way
DESCRIPTION QTY/HRS COST TOTAL
Primary underground relocation.
Excavation, slurry, concrete repair and asphalt repair. 1 34,535.00 34,535.00
Note: City of Ashland to supply PVC conduit, needed 0.00 0.00
misc., couplings/including fiberglass/PVC radius
sweeps, 1 vault as called out in electrical drawing.
THANK YOU FOR YOUR BUSINESS.
ESTIMATE IS GOOD FOR 30 DAYS FROM THE Total
ABOVE DATE. ITEMS NOT LISTED IN THIS $34,535.00
PROPOSAL ARE CONSIDERED AN EXTRA AND
WILL BE BILLED @ TIME & MATERIAL. ROCK OR SIGNATURE
OTHER MATERIAL THAT REQUIRE ROCK
BREAKING EQUIPMENT WILL ALSO BE @ TIME &
MATERIAL. ALL AGREEMENTS ARE CONTINGENT
UPON WEATHER OR DELAYS BEYOND OUR
CONTROL. Phone # Fax # E-mail
541-482-2289 541-512-8892 mayrock319@gmail.com
a
Copeland Construction, Ilc
321 Pruett Rd.
Eagle Point, OR 97524
Offcie: 541-826-2314
Fax: 541-826-1014
copelandconst.llc@earthlink.net
Date: 6/8/2016
To: Dave Tygerson/City of Ashland/Electric
Project: Primary Underground Relocation -85 Winburn Way
Price Includes the Following:
UNDERGROUND PRIMARY / COMMUNICATION / INFRASTRUCTURE AS PER ATTACHED ELECTRICAL LAYOUT
PLAN AND COA ELECTRIC SERVICE REQUIREMENTS.
PROJECT INCLUDES RESTORATION OF ALL PUBLIC & PRIVATE PROPERTIES AFFECTED DURING PROJECT.
ALL REQUIRED PEDESTRIAN / VEHICLE TRAFFIC CONTROL WILL BE THE RESPONSIBILITY OF THE CONTRACTOR.
COA IS RESPONSIBLE FOR STATE / CITY PERMITS THAT MAY BE REQUIRED FOR THIS PROJECT.
MATERIAL TO BE PROVIDED BY COA FOR PROJECT WILL INCLUDE: PVC CONDUIT, NEEDED MISCELLANEOUS
COUPLINGS/ INCLUDING FIBERGLASS / PVC RADIUS SWEEPS, (1) VAULT AS CALLED OUT IN ELEC. DRAWING.
SPECIAL NOTE: AREA WILL NEED TO BE SECURED FOR HEAVY PEDESTRIAN TRAFFIC DURING PROJECT.
We propose to furnish equipment and labor in accordance with
above specifications, For the lump sum of: $34,880.00
Mary McClary
From: Mark Holden
Sent: Friday, July 01, 2016 11:36 AM
To: Dave Kanner; Lee Tuneberg
Cc: Mary McClary; Michael Ainsworth; Dan Hendrix; Thomas McBartlett III
Subject: Mark Holden - Transfer of signature authority July 5 through July 11, 2016
1 will be out of the office from Tuesday, July 5 through Monday, July 11, returning to the office on Tuesday, July 12.
While out of the office I am transferring my signature authority to Michael Ainsworth.
Regards,
Mark Holden, director of IT and the electric utility
City of Ashland
Email: holdenm@ashland.or.us
Phone: 541.552.2314
This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records Law for
disclosure and retention. If you have received this message in error, please contact me at (541) 552-2314. Thank you.
Purchase Order
Fiscal Year 2017 Page: 1 of: 1
B City of Ashland
I ATTN: AP
L Purchase 15
L 20 E. Main
Ashland, OR 97520 Order #
T
O Delivery must be made within doors of
specified destination.
S
V JM CONSTRUCTION INC
E PO BOX 1637 I C/O Electric Department
N P 90 North Mountain Ave
D SHADY COVE, OR 97539 Ashland, OR 97520
O T
R O
M 1D-
(541) c afm-_ _ _ D
878-7810 _ DAVID TYGERSON
~Dffla -F;: 30)
07/12/2016 593 FOB ASHLAND OR City Accounts Pa able
P 7r
UTILITY INFRASTRUCTURE UPGRADE
The Above Purchase Order Number Must Appear On All
Correspondence - Packing Sheets And Bills Of Lading
1 UPGRADE EXISTING UTILITY INFRASTRUCTURE 85 1.0 $16,940.00 $16,940.00
WINBURN WAY - PRIMARY UNDERGROUND RELOCATION
AS PER ATTACHED PROPOSAL AND ELECTRICAL LAYOUT
PLANS.
CONTRACT FOR GOODS AND SERVICES UG PRIMARY
UPGRADE FOR 85 WINBURN WAY.
BEGINNING: 06/20/16
COMPLETION 09/16/16
GL Account: $16,940.00
GL SUMMARY
111800 - 704100 $16,940.00
By: -
Authorized Signature
By:
Authorized ignature =113301m. A $16,940.00
FORM 1 1 °-Q `Cxf I A ll `v' ll
SHLAND
e7'. r;,
REQUISITION Date of request: 6-2D-lb
Required date for delivery:
Vendor Name -1- C01V aYJC 7-1 Q TIV C
Address, City, State, Zip A n so /A37 S YNY E AR, 97M2
Contact Name & Telephone Number ~ 541-978- 7,610 1- 5,41,- W
Fax Number
SOURCING MET140D B - t ~ Z O/&,
❑ Exempt from Competitive Biddinq ` ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Coples 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 -of council approval required, attach co of CC
❑ Small Procurement Cooperafiive Procurement
Less than $5,000. El Request for Proposal (Copies on file) ❑ State of Oregon `
❑ Direct Award Date approved by Council: Contract#
El Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODSA SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
5 to $100,000 ❑ Written quote or proposal attached Agency
B(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 A, 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(wriften solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K.to $75K Valid until: Date - (Attach copy of council communication)
Description of SERVICES Total Cost
Qr/.f /7n/ I &fF/'i q 5rr-M U Cl ro ?
'A/ Y PATS?Iq Al Y t ` V1)'ERC_R U,1V ( 5LX_J _1n1 ~ L
E I L LAI ~A,
Item # Quantity Unit Description of MATERIALS Unit Price Total. Cost
TOTAL COST
M/Per attached quotelproposal $
- - ,
Project Number C,_6Q ZQ --7 ~ Account umber6clO- 1 1- le- 00 -7DgZ-QO .
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 -Y.es / No
By signing this requisition form, l certify that the City's public contracting requirements have been satisfied. ,
Employee: G
amQ= - Department Head;
(Equal#o orgreaterthan $5,000) -
Department ManagerlSupervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year. e!YEi I NO '7!`
Finance Director- (Equal to or great an $5,000) Date
Comments.
Form #3 - Requisition