HomeMy WebLinkAbout2016-228 Contract - Hassell Fabrication
Contract for Goods and Services
CITY Of CONTRACTOR: Hassell Fabrication
,ASHLAND CONTACT: Brett Hassell, Owner
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 300 Dead Indiana Road, Ashland, OR 97520
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-482-8730
DATE AGREEMENT PREPARED: 08/08/2016 FAX: 866-482-8858
BEGINNING DATE: August 15, 2016 COMPLETION DATE: October 31, 2016
COMPENSATION: $32,365.00 per Estimate #102-67 attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: 16' Transfer Ready Tub made to fit City's Transfer Trailer and
installed on Heavy Duty Cab & Chassis being provided by Tec Equipment per Estimate #103-67 attached as
Exhibit C. Approved b City Council on August 2, 2016.
ADDITIONAL TERMS:
In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and Services will be primary and take
precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a
manner that will not conflict with the said rims City of Ashland Contract.
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 27913.220, 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 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:
Contract for Residential Fire Sprinkler Demonstration Trailer, Page 1 of 5
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 tempts to assign rights in,
or delegate duties under, the Contract.,
4E of-
16. Insurance. Coritractor-shall at:ts,-ern expense provide thd following insurance:
a. e-Worker's Compensation in urwce in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' _corn pensaioTt coverage for all their subject workers
b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $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
Contract for Residential Fire Sprinkler Demonstration Trailer, Page 2 of 5
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.
Contrar: City of Ashland
By By 41,AA-
Signature
4
Print Name Print Name
0 W"a W- / L ?I--// onz~
Title Date
W-9 One copy of a W-9 is to be submitted with^
the signed contract. Purchase Order No.
qp AS TO FORM
orney
Ashl • i
~9
nat
Contract for Residential Fire Sprinkler Demonstration Trailer, Page 3 of 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has 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.
r
(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.
t
r
Contractor (Date)
Contract for Residential Fire Sprinkler Demonstration Trailer, Page 4 of 5
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
WA E
per hour effective June 30, 2016
(Increases annually every June 30 by the
' 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 Residential Fire Sprinkler Demonstration Trailer, Page 5 of 5
rte,,, _
CERTIFICATION OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE REQUIREMENTS
Contractor is exempt from the requirement to obtain workers compensation insurance under ORS
Chapter 656 for the following reason. Contractor is to initial the appropriate box as follows:
SOLE PROPRIETOR
(Initials) ■ Contractor is a sole proprietor, and
■ Contractor has no employees, and
■ Contractor will not hire employees or subcontractors to perform this contract.
CORPORATION - FOR PROFIT
(Initials) ■ Contractor's business is incorporated; and
■ All employees of the corporation are officers and directors and have a substantial ownership interest* in the
corporation, and
■ All work will be performed by the officers and directors; Contractor will not hire other employees or subcontractors
to perform this contract.
CORPORATION - NONPROFIT
(initials) ■ Contractor's business is incorporated as a nonprofit corporation, and
■ Contractor has no employees; all work is performed by volunteers, and
■ Contractor will not hire employees or subcontractors to perform this contract.
PARTNERSHIP
(Initials) ■ Contractor is a partnership, and
■ Contractor has no employees, and
■ All work will be performed by the partners; Contractor will not hire employees or subcontractors to perform this
contract, and
■ Contractor is not engaged in work performed in direct connection with the construction, alteration, repair,
improvement, moving or demolition of an improvement to real property or appurtenances thereto.**
LIMITED LIABILITY COMPANY
(Initials) ■ Contractor is a limited liability company, and
■ Contractor has no employees, and
■ All work will be performed by the members; Contractor will not hire employees or subcontractors to perform this
contract, and
■ If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the
construction, alteration, repair, improvement, moving or demolition of an improvement to real property or
ppurte ces thereto.**
(Signature of Authorized Signer) (Date)
0 C-,re cko(
(Signer'sTitle
*NOTE: Under OAR436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the
corporation, or if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average
percentage of ownership of all shareholders.
**NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing
construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption
request is accepted from a contractor who will perform construction work.
, pa
HASSELL FABRICATION, INC.
300 Dead Indian Memorial Road
Ashland, OR 97520 Date Estimate #
541-482-9730 7/29/2016 102-67
Name 1 Address
CITY OF ASHLAND
20 E MAIN STREET
ASHLAND OR 97520
Description City Cost Total
16' TRANSFER READY TUB MADE TO FIT CITY'S TRANSFER TRAILER. 1 18,455.00 18,455.00
INCLUDES DRIVER AND PASSENGER SIDE STEPS, REBAR WALK RAILS.
AND FENDER TOOL BOXES (WITH EXTRA STRENGTH FLOOR). 12"
APRON WITI1 SIDE CASTER ATTACHMENT POINTS.
HITCH PLATE--1/2" TI MATERIAL WITII 690L PREMIER HITCH 1,400.00 1,400.00
SUB FRAME 750.00 750.00
INSTALL TUB AND WET KIT (PTO AND PUMP FACTORY INSTALLED) 3,500.00 3.500.00
INSTALL SPOOL VALVE AND CONTROLS FOR SANDER 3225.00 3,225.00
PULL TARP WITH PROTECTIVE CAB GUARD COVER AND TARP TAMER 2,585.00 2,585.00
PAINT TUB WHITE. PAINT SUB FRAME AND HITCH BLACK 2.450.00 2,450.00
Total 532365.00
Customer Signature
DA DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 8/1/22016
016
~
CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
,~RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
PRODUCER CONTACT Joanne Abels
:
NAME
KPD Insurance, Inc. PHONE 541-741-0550 FAX 541-741-1674
PO Box 784 E-MAIL ,joannea@kpdinsurance.com
Springfield OR 97477 ADDR
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Hartford Fire Insurance Co. 19682
INSURED HASS01 C INSURER B :
5 Hassell Fabrication, Inc. INSURER C :
300 Dead Indian Memorial Rd INSURER D :
Ashland OR 97520
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1920226815 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 POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDrCM
A X COMMERCIAL GENERAL LIABILITY Y 52UUNSV7401 6/15/2016 6/15/2017 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence $300,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO- PRODUCTS - COMP/OP AGG $2,000,000
x POLICY 11 JECT LOC $
OTHER:
A AUTOMOBILE LIABILITY 52UUNSV7401 6/15/2016 6/15/2017 Eaacciden SINGLE LIMIT $1,000,000
ANY AUTO BODILY INJURY (Per person) $
ALTOWNED SCHEDULED BODILY INJURY (Per accident) $
S AUTOS
NON-OWNED PROPERTY DAMAGE $
X HIRED AUTOS X AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
-
WORKERS COMPENSATION PER STATUTE ER OTH
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
A Property 52UUNSV7401 6/15/2016 6/15/2017 Special Form
Replacement Cost
$2,500 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Certificate holder is named as Additional Insured as respects to General Liability when required by written contract per HC 26 69 06 05.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
90 N Mountain Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
Purchase Order
Fiscal Year 2017 Page: 1 of: 1
I
L- -10
l ld- = _ _ _P Qf~lA- L
I We - - - - - fhT ARTE
B City of Ashland -
I ATTN: Accounts Payable
L 20 E. Main Purchase n
L Ashland, OR 97520 Order # 9
T
O
V HASSELL FABRICATIONS, INC H C/O Fleet/Shop Division
E 300 DEAD INDIAN MEMORIAL RD 1 90 North Mountain Ave
N P Ashland, OR 97520
D ASHLAND, OR 97520 Phone: 541/488-5358
O T Fax: 541/552-2304
R O
Ien or P-hdh -I lumSer d N`-a 1 fflm_ tr$~ = = ~ = - _ - - - -
-
Wes Hoadle
Date O derdr NV &d-or- r= a e F~~uni - - - • -
08/18/2016 226 FOB ASHLAND OR City Accounts Payable
Ifem# _ - - - [enZP2r=_
E WO
16' Transfer Tub (Veh 1027)
The Above Purchase Order Number Must Appear On All
Correspondence - Packing Sheets And Bills Of Lading
1 16" Transfer Ready Tub (Vehicle #1027) 1.0 EACH $32,365.00 $32,365.00
Department: Street
Vehicle: #1027 (Replacing 36)
Contract for Goods and Services
Beginning date: 08/15/2016
Completion date: 10/31/2016
GL Account: $32,365.00
GL SUMMARY
081000 - 703000 $32,365.00
s
B Date:
Y:
Authorized Signature $32 365.00
#3 1, CITY OF
ORM
_
^ASHLAND
REQUISITION Date of request: 8/15/2016
Required date for delivery:
Vendor Name Hass JLF;;hriratinn IN('
Address, City, State, Zip 300 Dead Indian Memorial Road Ashland OR 97520
Contact Name & Telephone Number Brett Hassell 541-482-8730
Fax Number
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached _(Attach co of council communication _ If council approval required, attach co of CC
❑ Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Date approved by Council: Contract #
❑ Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ® Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5,000 to $100,000 ❑ Written quote or proposal attached Agency
❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement
$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
Build and install bed as per attached quote exhibit C $323365.00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
® Per attached quote/proposal
Project Number - - - - - - - _ - - Account Number 7 3 0 - 0 8 -1 0 - 0 0 - 7 0 3 0 0 0
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:
I T Director Date Support -Yes / No
By signing this requisition form, I certify that the Cites-public contracting requirements have been satisfied.
m
EmptoYee:~ - Department Head:° .
'
(Equal to of ter-ffian $5,000)
Department Manager/Supervisor: City Administrator:
(Equal to or greeter than $25,000)
Funds appropriated for current fiscal year: YES / NO
Finance Director- (Equal to orgreaterthan $5,000) Date
Comments:
Form #3 - Requisition