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HomeMy WebLinkAbout2016-307 Contract - Sights & Sounds Unlimited Contract for GOODS AND SERVICES Small Procurement Less than $5,000 INDEPENDENT CONTRACTOR: Apple Box Marketing & Media dba Sight & Sounds CITY Of Unlimited, Inc ASHLAND CONTACT: Jes Webb 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1867 Williams Highway (physical) Telephone: 541/488-6002 703 Towne Street (mailing) Fax: 541/488-5311 Grants Pass, OR 97527 info@ssounds.com TELEPHONE: 541.476.8558 FAX: BEGINNING DATE: 10/21/2016 COMPLETION DATE: 12/31/16 COMPENSATION: $1875 GOODS AND SERVICES TO BE PROVIDED: Contractor will provide filming and editing of two versions of a 60 second PSA. Contractor will provide release forms for talent. Ashland Fire & Rescue to provide script, talent, props and locations. In the event of conflicts or discrepancies among Contract Documents, this standard form of the City of Ashland Contract will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with this standard form City of Ashland Contract. Revised 10-28-14 Page 1 of 3 NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City. 4. Statutory Requirements: ORS 279B.220, 279B.225, 279B.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 5. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from those losses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this contract by Contractor its employees, or agents. Contractor shall not be held responsible for any losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City. 6. Termination: City's Convenience. This contract may be terminated at any time by the City. 7. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 8. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. 9. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 11. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 12. Default. The Contractor shall be in default of this agreement if Contractor commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract. 13. Insurance. Contractor shall at its own expense provide the following insurance: a. a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENALTY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: b. General Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 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 $1,000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: j City of Ashland: ign tdne Departme t Head Print a Print Name (zf22 I/ 4~ _ / 1) 4 Title Date W-9 One copy of a W-9 is to be submitted with the signed contract.N py Purchase Order No. Revised 10-28-14 Page 2 of 3 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 service ' o provided. ntr c~r (Date) / Revised 10-28-14 Page 3 of 3 PROPOSAL and BID FOR CITY OF ASHLAND Specifically ASHLAND FIRE & RESCUE SUBMITTED BY: Apple Box Marketing & Media, A DBA of Sights & Sounds Unlimited Incorporated Established 1989 1867 Williams Highway, physical 703 Towne Street, mailing Grants Pass OR 97527 Office -(5 41)47 6-8 5 5 8 info gssounds. com September 22nd, 2016 Authorized Representative e~ kca 9/22/16 Pre ' ent/CEO Jes Webb Date j esingpggmail. com 1 Apple Box Marketing and Media (appleboxmm.com) is a forward-thinking, flexible and creative content agency born from its parent company Sights and Sounds Unlimited. We began as a small, part time company of modest means in 1989 providing special event services. Today, we have evolved into a content production agency, providing advertising, marketing, and video production (in addition to our original services). We believe our skill set makes for an excellent option for fulfilling the PR and marketing needs of both public and non-profit agencies. Our current office is located at 1867 Williams Highway in Grants Pass, Oregon (97527). Our full time office manager staffs the office from 10:00-5:00 Monday through Friday. Additional staff (classified as part time) are on call and as needed. Currently our company has two full time and six part-time employees. We also employ independent contractors for specific tasks. These independent personnel meet or exceed the requirements commonly in use by our industry. In addition to meeting the minimum requirements set forth by the IRS. Ashland Fire & Rescue is requesting a formal bid for production of a PSA program with two 60 second versions. Upon completion of both versions, the project will be made broadcast, and social media ready. Loop- able versions for community outreach will also be made available as requested. In addition to the City of Ashland Fire & Rescue's PSA bid & overview, it is our understanding that AF&R will also provide the included script that was made available along with the bid sheet. In addition, it would be our hope that an agency member would be made available for logistical and scheduling purposes. Further Stipulations and disclosures. • Applebox will provide Ashland with copyright free copies of all material shot for the aforementioned PSAs. • Release forms of our own design will be provided for all on screen talent. • Completed project will be provided by November 1 st 2016. However, our schedule would require principle shooting to take place before October 5th, with "pickup shots", taking place by October 20th • Applebox will retain no rights to any completed PSA. • Excel Spreadsheet pricing includes 60 second Version 1 and 60 second version 2 as stated in the bid request Sample of PSA Work 60 seconds or longer httpsJ/vimeo.com/1 59830391 https J/v i meo. co m/ 131726890 30 second PSAsBroadcast https://vimeo.con/105525492 httpsJ/vimeo.con-/131734260 httpsJ/vimeo.com/52864752 2 16 Ix Budget Proposal for Ashland Fire + Rescue ABOVE-THE-LINE Budget 10000 Script & Rights $0.00 11000 Producer/Director $300.00 12000 Actors $0.00 ABOVE-THE-LINE Totals: $300.00 PRODUCTION Budget 14000 Production Dept. $0.00 15000 Crew $500.00 16000 Equipment $300.00 17000 Art $150.00 18000 Miscellaneous $50.00 19000 Media $0.00 PRODUCTION Totals: $1,000.00 Post Budget 20000 Editing $500.00 21000 Sound $75.00 POST Totals: $575.00 Grand Totals $1,875.00 ' 11 ` " ' Arc VEHICLE OR EQUIPMENT CERTIFICATE of INSURANCE 10/2012016 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- This form Is used to report coverages provided to a single specific vehicle or equipmeaL Do not use this farm to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 26 for that purpose. PRODUCER NACONTACT ME: DINA TAGLIERE P"ONE C Na Ext : (541)479.3339 j~ No l: (541)479-7893 BILL THORP INSURANCE AGENCY, INC. PO BOX 520 E-MAIL ss dlna.m.tagilere.Nix@statefarm.com CUSTOMER ID GRANTS PASS OR 97528 INSURER(S) AFFORDING COVERAGE NAIC A INSURED INSURER A : State Farm Mutual Automobile Insurance Company 23178 JES & AMY WEBB INSURER B : 703 TOWNE ST INSURER C : INSURER D : GRANTS PASS UR 97527 INSURER e : DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MAKE I MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 2012 FORD F150 PICKUP 1 FTFW1 ET4CFA20674 DESCRIPTION VEwCLErEQUIPMENT VALUE SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HASMAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S) 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 POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR Aoe't POLICY EFFECTIVE POLICY EXPIRATION LTR INSIM TYPE OF INSURANCE POLICY NUMBER DATE JNMDDdYYYY) DATE (MWDDIYYYY) LIMITS VEHICLE LIABILITY COMBINED SINGLE LIMIT $ x 117 5579-D01-37C 10101/2016 ()4/{1112017 BODILY INJURY (Pet parson) $ 1,000,000.00 BODILY INJURY (Pet eaadent) $ 1,00D,000.00 I PROPERTY DAMAGE 1,000,000.00 i GENERAL LIAE M.ITY EACH OCCURENCE $ OCCURRENCE GENERAL AGGREGATE $ CLAIMS MADE $ INSR Less POLICY EFFECTIVE POLICY EXPIRATION LTR PAYE TYPE OF INSURANCE POLICY NUMBER DATE (MWDD rfM DATE (MMIDDfY" LIANTS I DEDUCTIBLE VEH COLLISION LOSS ❑ ACV ❑ AGREED AMT s LIMIT X 117 5579-DOl-37C 1010112016 04/0112017 ❑ ❑ STATED AMT $ 500.00 DED x VEH COMP L_j VEH OTC 117 5579-D01-37C 10101/2015 W0112017 ❑ ACV ❑ AGREED AMT $ LItWT ❑ ❑ STATED AMT $ 500.00 DED I EQUIPMENT ❑ ACV ❑ AGREED AMT LIMIT BASIC H BROAD ❑ RC ❑ STATED AMT DED SPECIAL ❑ REMARKS (INCLUDING SPECIAL CONDITIONS 18THER COVEMOES) (Attach ACORD 101, Add#tloml Remart s Schedule, If more space Is required) ADDITIONAL INTEREST CANCELLATION Select one of the fallowing: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The additional interest described Wow has been added to"pef"Ies) listed herein by po" number(s). BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE A rreBqquest has been submitted to add the eddlional interest described below to the policy(ies) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I'sted herein policy num s . VEHICLE! EQUIPMENT INTEREST: LEASED FINANCED DESCRIPTION OF THE ADDITIONAL INTEREST NAME AND ADDRESS OF ADDITIONAL INTEREST ADDITIONAL INSURED LOSS PAYEE LENDER'S LOSS PAYEE LOAN I LEASE NUMBER ATNE ~ @ 1997-2015 AC D COWORATION, All rig rued. ACORD 23 (2©16103) The ACORD name and logo are registered marks of ACORD 1004361 142987.3 41-26-2018 nco CERTIFICATE OF LIABILITY INSURANCE tDATEo o/ /20/2o/YY 6 16 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 have ADDITIONAL INSURED provisions or 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: Misty D Whorley Hart Insurance Agency PHONE FAX PO Box 1240 C No xt: (541) 479-5521 A/C No: E-MAIL Grants Pass OR 97528 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:American Hallmark Ins Co of TX 43494 _ INSURED (541) 660-2182 INSURER B: SAIF Corporation 36196 Sights & Sounds Unlimited Inc INSURER C : 703 Towne Street INSURER D: Grants Pass OR 97527 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 1555 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 ADDLSUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE F OCCUR 44CL461751 10/01/2016 10/01/2017 PREMISES (Ea occurrrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENI AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT 1:1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS' LIABILITY Y/ N 746048 01/01/2016 01/01/2017 X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑Y N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland/Ashland Fire Rescue ACCORDANCE WITH THE POLICY PROVISIONS. 455 Siskiyou Blvd AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 . CITY OF ASHLAND OFFICIAL RECEIPT 20 East Main Street Ashland, Oregon 97520 Receipt Number 00046860 (541) 488-6004 Receipt date 10/21/2016 Payee name SIGHTS & SOUNDS UNLIMITED INC. Tender type Charge Customer NO: 1024468 Check number Activity # Description Amount 00054315 Application 25.00 License type Temporary License (30 days) Receipt amount 25.00 Purchase Order Fiscal Year 2017 Vim& Page: 1 of: 1 r MU=~P_eEA~0 AL;L - B City of Ashland ATTN: Accounts Payable L 20 E. Main Purchase 414 L Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us U SIGHTS AND SOUNDS UNLIMITED, INC H C/O Fire and Rescue Department E 703 TOWNE STREET 1 455 Siskiyou Blvd N P Ashland, OR 97520 D GRANTS PASS, OR 97527 Phone: 541/482-2770 O T Fax: 541/488-5318 R O VC or, Phone Number-- Vd&lQrx=Nffl Mar ueritte Hickman date Or~ereu _ U~n~oeNum=ber~ =bats-l~s~uirsd=-- ---~-r.~r~6~1- - - - _ ~~n = ~n-_ 11114/2016 2671 City Accounts Payable 1t_m# L~escc~ tiQnlPartt - _ _ _J_- =x-fr d1?ric Public Service Announcement 1 Filming and production of a 60 second Public Service 1 $1,875.0000 $1,875.00 announcement in two versions. Project #00480.999 Contract for Goods and Services Small Procurement Less than $5,000 Beginning date: 10/21/2016 Completion date: 12/31/2016 GL SUMMARY 075100 - 610300 $1,875.00 J By: < Date a Authorized Signature = - - - _ - $1,875.00_ FORM #3 CITY OF ASHLAND REQUISITION Date of request: 11/7/2016 Required date for delivery: Vendor Name Anr11P. Rnx MarkPtinn R MPrlia rlha 0,inhts R Srninds, I Inlimited, Inr Address, City, State, Zip 703 Towne Street, Grants Pass, OR 97527 Contact Name & Telephone Number Jes Webb 541,476.8558 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 Filming & Production of a 60 second Public Service announcement in two versions $ 1875.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quote/proposal v Project Number 00480 - 999 Account Number 110 - 07 - 51 - 00 - 610300 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 re ~ . sition fonp, 1 certify that the City's public contracting requirements have been satisfied. I-j s 4- jv~ a f Employee: f~ - Department Head: vj F p I (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