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2016-190 Contract - B&B Fire Suppression
Contract for GOODS AND SERVICES Less than $25,000 C I T Y OF CONTRACTOR: B& B Fire Suppression, LLC ASHLAND CONTACT: David Bryant 20 East Main Street Ashland, Oregon 97520 ADDRESS: 823 Columbine Way, Central Point, OR 97502 Telephone: 541/488-6002 Fax: 5411488-5311 TELEPHONE: 541.951.5596 DATE AGREEMENT PREPARED: 7/7/16 FAX: 541.664.4234 BEGINNING DATE: 7/11/16 COMPLETION DATE: 10/31/16 COMPENSATION: As specified on bid for each property. And as specified on submitted quote for the contract with hand written clarification based on a phone call with David Bryant. GOODS AND SERVICES TO BE PROVIDED: Weed abatement - Contractor to perform assigned weed and vegetation abatement ("Project") on both private and public properties as determined out of compliance with Ashland Municipal Code. Prior to performing a Project, Contractor shall abide by AFR written direction as to the location, scope, date and time to perform the Project. Contractor to abide by specific property bid as individually established by AFR. Specific bids include all costs of project including equipment and personnel. If contractor shows up on site and the job in already complete, they will still get paid $150 for the engine and 1 hour for each person brought to the job site. 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 b Contractor to perform work or services attendant to this Contract for Goods and Services Less than $25,000, Page 1 of 6 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 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: Contract for Goods and Services Less than $25,000, Page 2 of 6 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: $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: $1,000,000 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. 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 Goods and Services Less than $25,000, Page 3 of 6 Contractor: City of Ashland By By Signature Department Head o~ t¢" Print Name Print Name Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. V Contract for Goods and Services Less than $25,000, Page 4 of 6 Jul 06 16 07:00a B & B Fire Suppression 541-664-4234 p.2 1 1 B & B Fire Suppression LLC 823 Columbine Wav Central Point, OR 97502 Iii Margueritte, We are submitting our quote & terms to do weed abatement. 1. $150.00 per day for the use of our Type 6 fire engine, that will be brought out on every job site. 2. $30.00 an hour per every person that we bring to the job site. 3. If B&B Fire Suppression LLC bids on a job and gets accepted for the job bid-- If we show ru and the ' ob is already done by ~ el someone else, I50.00 for bringing the fire engine out, and minimum charge of 1 hour per each person that we have brought out to the job site with us. 4. If B&B Fire Suppression LLC gets called out for wildland fires, it will be our first priority over everything. We will NOT be held accountable in any way, if the job is not completed because of this. If applicable, when we get back from fires, we can resume and complete the job we started without further delay. Iv*-An -VvJ 0 6105 Thank you very much , David Bryant & Tire Bailey Jul 06 16 07:01a B & B Fire Suppression 541-664-4234 p.3 z cn D m m m m D Q fl m C) N co © U' z Q° CTJ SCI O -n ~ > U3 'U :E: -1 .h o g! cn co z C C!) z - o c z~ W (D C7 cn rn 0 O ~U C A C11 o z -I Q z -t, z 'T1 3 z ;D o U) z D mr mD Z :z o z rn z m x > C-n -V A OSe m M JJ Y• " l z cn m -o cn rn --1 m o cn Z a D C13 0 o z o 03 -1 V'c x o c D~ a c L m~ ~ w n m%4 m m ~ 1 06 16 07:00a B & B Fire Suppression 541-664-4234 p.1 ■ ■ FAX From: B & B Fire Suppression, LLC David Bryant: 541-951-5596 Tint Bailey: 541-761-0094 Fax: 541-664-4234 * * ATTENTION : Margueritte Hickman * * CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 7/12/2016 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: Pam Dressler Little River Investments AICNE Ext: (541)536-1726 AX No: (541)536-1568 51477 Hwy 97 AD RIESS: Pam@bancorpinsurance. com P.O. BOX 327 INSURER(S) AFFORDING COVERAGE NAIC # La Pine OR 97739 INSURERA Arch Insurance Company 11150 INSURED INSURERB :SAIF Corp B & B Fire Suppression LLC INSURER C 823 Columbine Way INSURER D INSURERE Central Point OR 97502 INSURERF COVERAGES CERTIFICATE NUMBER:CL1671219672 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000, 000 DAMAGE TO RENTED A CLAIMS-MADE XI OCCUR PREMISES Ea occurrence $ 1,000,000 X MWPK07445406 12/21/2015 12/21/2016 MED E.XP (Any one person) $ 5,000 PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000 X POLICY F- PROJECT- E LOC PRODUCTS - COMP/OPAGG $ 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY (Per person) $ A ALL OVvNED SCHEDULED _ AUTOS X AUTOS X MWPK07495906 12/21/2015 12/21/2016 BODILY INJURY (Per accident) $ NON-O'NWED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X 19 PIP-Basic $ 15,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ MWUM07574101 12/21/2015 12/21/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER,`EXECUTIVE n E L. EACH ACCIDENT $ 500,000 OFFICERIMEIvIBER EXCLUDED? u NIA B (Mandatory in NH) 748855 AR 3/1/2016 3/1/2017 EL DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ S00,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder City of Ashland, Oregon and its elected officials, officers and employees are named as Additional Insured. Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION (541) 488-5311 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 Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Pam Dressler/CLL © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD NS025 (201401) 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. (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. 71 e~ r Contractor (Date) Contract for Goods and Services Less than $25,000, Page 5 of 6 Purchase Order Fiscal Year 2017 Page: 1 of: 1 THIS _NU AIIlL.PEAi 01 ALL_: B City of Ashland INVOICES, PAG1SAGESAND SHIPPING PAPERS, I ATTN: AP - - L Purchase 31 L 20 E. Main Order # Ashland, OR 97520 T O Delivery must be made within doors of specified destination. V S E B & B FIRE SUPPRESSION H N 823 COLUMBINE WAY C/O Fire and Rescue Department D CENTRAL POINT, OR 97502 P 455 Siskiyou Blvd O T Ashland, OR 97520 R O sarPi a) umE er _ lt6nciQr Fad=Number Requist 0n. Nufte.r . Delive efere ....v: 541 951-5596 M H ICKMAN tQTdr Ver~WNumber Date Required Freight l~fetfodlTerms Dpp ttrnnton = 07/18/2016 1421 FOB ASHLAND OR Cit Accounts Pa able _f Descri t _n.PartN'o QTY U. [ _ Unft-Psl rr i ?r WEED ABATEMENT The Above Purchase Order Number Must Appear On All Correspondence - Packing Sheets And Bills Of Lading 1 Weed Abatement 1.0 $2,500.00 $2,500.00 Contract for Goods and Services less than $25,000 Beginning: 07/11/16 Completion: 10/31/16 GL Account: $2,500.00 GL SUMMARY 075100 - 610500 $2,500.00 By: Authori ed ~ignatLV6 _ B Authorized Signature Pa T~ia{ $2,500.00 FORM #3 CITY OF ASHLAND REQUISITION Date of request. 7/14/16 Required date for delivery; ASAP Vendor Name B& B Fire Suppression, LLC Address, City, State, Zip 823 Columbine Way, Central Point, OR 97502 Contact Name & Telephone Number David Bryant 541,951.5596 Fax Number 541.664.4234 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 Date approved by Council: ❑ Direct Award -(Attach copy of council communication) 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 $5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date - (Attach copy of council communication) Description of SERVICES Total Cost Weed Abatement $ Not to Exceed $2500 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quotelproposal $ Project Number 000210.999 Account Number 110-07-51-00-610500 Account Number - - - - Account Number - - - - - - - *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes/ No By signing this requisition form, l certify that the City's public contracting requirements have been satisfied. Employee: ar ~;tr0 Department Head: mss = (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 Comments: Form #3 - Requisition