HomeMy WebLinkAbout2017-051 Contract - Liquivision Technology
Contract for GOODS AND SERVICES less than $25,000
CITY OF CONTRACTOR: Liquivision Technology
ASHLAND CONTACT: Sherri Trigg
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 711 Market Street Klamath Falls, Oregon 97601
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: (800) 229-6959
DATE AGREEMENT PREPARED: 2-16-17 FAX: (541) 883-1361
BEGINNING DATE: 3-1-17 COMPLETION DATE: 6-30-17
COMPENSATION: Not to exceed $3,500 per quote and scope of work attached as "Exhibit C"
GOODS AND SERVICES TO BE PROVIDED: Clean and Inspect Crowson Reservoir using potable water
equipment and methods compliant with ANSI/NSF 61 and all applicable AWWA standards.
ADDITIONAL TERMS:
Cleaning and inspection must be completed on or before June 30th 2017
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 any time by mutual consent of both parties.
b. City's Convenience. This contract may be terminated at an time b City upon 30 days' notice in writing
Contract for Goods and Services Less than $25,000, 06/30/2016, Page 1 of 5
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
Damage.
Contract for Goods and Services Less than $25,000, 06/30/2016, Page 2 of 5
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. 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.
Contractor: City of Ashland
Y By IL
ignature Department Head
y
Print Name Print Name
Title Date
W-9 One copy of a W-9 is to be submitted with 0
the signed contract. Purchase Order No.
Contract for Goods and Services Less than $25,000, 06/30/2016, 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
~71specific 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.
, 1 (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.
Contractor (Date)
Contract for Goods and Services Less than $25,000, 06/30/2016, Page 4 of 5
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
W F=
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 projector 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, 06/30/2016, Page 5 of 5
~r
UQUONViSONON TkCHNOLOGY
DIVING SERVICE S
ffiae.10aiIirg,^-.ogress Phcre. ;800; 2-79-eSfa Fax: :F41, 8833-13e1 Vesterr Opersticrs
711 Iviar7ket Street Iigi,ivisicrgoiv ir@serrioc-a.~rr 82F r-Aarwet Street
Klarr,ath Falls, OR 57F01 .•;F,~. ivir,g> rwi s. m Klarrsth Falls, CR 57F01
Steve Walker 2/7/2017
Ashland, City Of Wk: 541-552-2326
90 N. Mountain Ave. Fx: 541-552-2329
Ashland, OR 97520 *OR6568-17r1 T_
We are pleased to provide you the following firm quotation and outline of the conditions of our services.
Tank Type Dia. Hgt. Maximum Surface Price for Price for Price for
or (Feet) Calculated Area Diver Diver Additional
LxW Capacity (S. F.) Inspection Cleaning & Sediment
Feet Gallons Only inspection Per Hour
Mobilization Charge - Flat charge to mobilize and demobilize to your location. $450 $375
1. Crowson BG Concrete 145X115 22 2,500,000 16,675 $3,050
Price includes Filter bag and De-Chlorination.
i
Subtotal l $3,500
Multitank Discount (after the first two tanks).
I ~
Total *Plus sales tax if applicable $3,500
Scope of Work:
Removal of accumulated sediment from the floor of the tank. The effluent will be disposed of at the districts direction. A
final and comprehensive inspection will be performed documenting the condition of the entire structure and recorded on
DVD. Written documentation with digital pictures, descriptions of the images and any recommendations will be provided to
the district on a USB flash drive.
Our bids are based on a variety of factors that pertain to the length of time it takes to accomplish our work. The main
consideration is the amount of sediment that has to be removed, 4" of normal sediment is included in this bid.
Initials Please initial the line items below to verify that you have reviewed them.
Entry hatch on top of the tank is at least 18" dlameter(If divers cannot enter minimum charges will apply
The water level is kept within ten (10) feet of the top of the tank.
Tank dimensions are correct.
Scope of work is correct.
1. Placement and disposal of effluent removed from the tank is done at the direction of the Customer.
2. Quotes for cleaning assume that the sediment is normal material (such as silt, flocculated material, insects,
manganese, rust, etc.) found in potable water tanks that is easily removed by our vacuum system. If the sediment is
difficult to remove such as large amounts of concrete chips, gravel, sand, rocks, detached coating debris, etc., then
our hourly rate shall apply for each hour (over the first hour) for removing this material.
71 1 Market Street
Klamath Falls, OR 97601
Phone: (541) 883-6473
LiQUIVISION TECHNOLOGY Fax: (541) 883-1361
3. Unless specified in quote detail we clean all submerged horizontal and angled berms or sloped surfaces 35 degrees
or less. Surfaces exceeding this angle such as the walls can be cleaned but must be listed separately in the quote
detail or estimated by the divers upon inspection. We do not clean surfaces that are out of the water.
4. If any information provided to us is incorrect or if any problems exist that inhibit our ability to complete the job on a
timely schedule, then we will notify you of the problem and reserve the right to add on to the quote based on our
estimate of the additional time it will take to complete the work. Charges for time delays are $200 per hour. This
paragraph only applies to any problems that are your responsibility (i.e. rescheduling with less than 2 business days
notice, set up and start of work before cancellation, etc.) Charge for going remote (if required and not addressed in
advance) is $375 per hour.
5. For coating repair in steel tanks we use a two part underwater epoxy. Each rust nodule or area of coating defect is
wire brushed to bare metal and epoxy is applied over the area. The epoxy chemically bonds to the steel, displaces
water, and remains intact with a greater bond than the original coating. All of our repair, sealing and coating materials
meet or exceed NSF 60 & 61 standards. Repairs are done at the districts direction for the rate of $375 per hour and
$35 per tube of Manus or epoxy.
6. If dechlorination is required it will be charged at $15.00 per hour. If filtration is required then the filter bags will be
charged at $200.00 per bag. Unless specified LVT does not remove the bags they become the districts responsibility
to dispose of.
7. If payment is not made within sixty days of the date of the invoice, an interest charge of 3% shall begin to accrue each
month on the unpaid balance. This interest will continue to accrue each month until the balance is paid in full. To
avoid any interest charges, payment must be received or postmarked within the sixty days following the date of the
invoice. Statements will be sent each month to reflect the new balance. Final pricing may be adjusted to reflect
prevailing wage requirements if it is not determined before job outset.
Our cleaning procedure is accomplished utilizing our proprietary vacuum cleaner, the "LiquiVacTM" (Patented). The
LiquiVacTM pumps an average of 200 gallons per minute. It has a rotating soft bristle brush that scrubs the floor clean and
removes all sediment without creating turbidity in your tank. This is the only way to ensure that all biofilm is removed from
the interior surfaces without getting any of it mixed into the water column. This system also enables us to clean walls.
In a conscious effort to preserve our nations natural resources LVT will provide our reports to the district on USB flash
drives. If you require a printed and bound copy of the reports please notify our office staff. There will be an additional fee of
$125 per copy.
In over 20 years of providing diving services we continue to treat every customer as if they were our only customer. We
are dedicated to accomplishing every job with the utmost professionalism, safety and efficiency.
Please sign this quote and FAX both pages back to us with an approximate time frame of when you would like the work
done. If you have any questions please give us a call. We look forward to working with you.
Quote is valid for 90 days. Upon signature the work shall be accomplished at a mutually acceptable date within one year.
Sincerely, I find the above and preceding page of contingencies and procedures
acceptable.
Accepted b : Date:
John N Bowers
Sales/Financial Mgr. Signature: Title:
711 Market Street
Klamath Falls, OR 97601
► ` Phone: (541) 883-6473
LiQuIVISION TECHNOLOGY Fax: (541) 883-1361
Billing/Change Order/Estimate Form
Steve Walker 2/7/2017
Ashland, City Of Wk: 541-552-2326
90 N. Mountain Ave. Fx: 541-552-2329
Ashland, OR 97520 *OR6568-17r1 T_
Team Leader: Diver #1:
Diver #2 Diver #3:
Tank Type Dia. Hgt. Maximum Surface Price for Price for Date
or (Feet) Calculated Area Diver Diver Work
LxW Capacity (S.F.) Inspection Cleaning & Done
Feet Gallons OnI Inspection
Mobilization Charge - Flat charge to mobilize and demobilize to your location. $450
1. Crowson BG Concrete 145X115 22 2,500,000 16,675 $3,050
it
Price includes Filter bag and De-Chlorination.
I
Subtotal $3,500
Multitank Discount (after the first two tanks).
Total -Plus sales tax if applicable $3,500
Itemize work: Time or Quantit : Extended:
Sales Tax if an :
Total
Authorization Signature:
Estimation of cost for recommendations that LVT can erform.
Recommendations: Estimated Labor Total Estimate
Total
AC40 CERTIFICATE OF LIABILITY INSURANCE ~o 2 ;z DNYYY)
017
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 cediflcate holder is an ADDITIONAL INSURED, the pollcy(les) 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). %AMTACT
PRODUCER NAME: Janice S Sharp
Great Basin Insurance PHONE
PO Box 69 (541) 882-SS07 No:
E-MAIL
Klamath Falls OR 97601 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAICB
tNSURERA. Great AMOrican Insurance Gsoup 16691
INSURED (5i1) 883-6473 DySURER 6: Starstone National Insurance Co
Liquivision Technology Inc. and Arrow
manufacturing, X=- INSURERC: LM Insurance C tion
711 Karket St. INSURER D: Azeric= States xnaurance Co. j
Klamath Falls OR 97601 INSURER E : American States Tnsurm =e Camp --119704
DISURER F: I
COVERAGES CERTIFICATE NUMBER: Cart ID 2 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
JI TYPE OF INSURANCE Imim POLILY NU MBER POLICY T Eff POLICY EXP LIMITS
A x COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 11000,000
CLAIMS40M a OCCUR Y CXK2205785 09/01/2016 09/01/2017 pREMWAS Eao=xence S 501000
I MED EXP Ony «m person} s 51000
X1 Limited pollution-lK PERSONAL a AOV INJURY s 11000,000
GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
X POLICYD~ELal FILOC PRODUCTS -COMPlOPA{3G S 11000,000
OTHER: S
AUTOMOBlLEtJABILnY : 1,000,000
g x ANY AUTO Y OIC171167540 08/01/2016 08101/2017 SOOCLYINJURY (Perperson) S
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per aeci0eett) S
S
WRED AUTOS ONLY AUTOS ONLY Per oppgo)
s
8 UOrBRELLALIAS HICLAIMS-MADE OCCUR Y OICX711675-4 08/01/2016 08/01/2017 EACHOCCURRENCE S
EXCESS LIAR AGGREGATE S
I OED RETENTION S s
WORK COMPENSATION - PE
x ANDEMPLPLOYERS'UASUTY YIN WCS-398-319580-0215 10/01/201610/01/2017-11 STAT E ERH'
ANYPROPRIETOR/PARTNER/EXECUTIVE F-~ NIA E.L. EACH ACCIDENT S 1,000,000
OFFICERIMEMBEREXCLUDED7
(Mandatory In NH) E.L. DISEASE - EA EMPLOYE S 11000,000
E L DISEASE -POLICY uaatr s 1,000,000
IOESCRI OF OPERATIONS blow
s
s
DESCRIPTnON OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101. Additional Remarks SMsdulo. may be attached tr more spew Is regtdrod)
City of Ashland, Oregon is an additional insured per the attached policy endorsement forms.
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 ACCORDANCE WITH THE POLICY PROVISIONS.
90 N. Mountain Ave. AUTHORREDREPRESENTATIVE
Ashland OR 97520
0 1 988-201 5 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Page 1 of 1
09/01/2016 * OMH2205785
Great American Insumace Company
0161456
o GAI2M Wd.0101)
anFftVAd
GR~A ERrrCAH CWhOHN 4SM2-ml
INN"= aW 110=11=0
MARINE COMMERCIAL LIABILITY
BLANKET ADDITIONAL INSURED ENDORSEMENT
we agree that this poitey shat) indude as AddEonai Insureds wW person or organb atton to whom the Flamed Insured has
agreed by written oanWd to provide coverage. M ady with respect to operdons peftmed by or on behalf of the
Framed bmied and only with respect to an'oaaarence':
1. Othewlse covered by this policy; and
2. That occumad aft"ueM to the making of such when agreement.
AU other temw and conditions of this policy remaln unchanged.
CAI 2391(Ed.01101) (Page 1 of 1)
REPRMW FROM THE ARCHIVE. THE oRMM TRANSACTION MAY DICLUCE AMMON& MRUS
COMMERCIAL AUTO
Policy 01 0171167540 CA 71 10 03 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORD
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED
Paragraph 2.b. of the CANCELLATION Common SECTION Il - LIABILITY COVERAGE - A.I. WHO
Policy Condition is replaced by the following: IS AN INSURED provision is amended by the addition
b. 60 days before the effective date of cancellation of the following:
If we cancel for any other reason. e. Any person or organization for whom you are re-
quired by an insured contract" to provide insur-
TEMPORARY SUBSTITUTE AUTO - PHYSICAL ance is an insured", subject to the following
DAMAGE COVERAGE additional provisions:
Under paragraph C. - CERTAIN TRAILERS, MO- (1) The 'insured contract" must be in effect
BILE EQUIPMENT AND TEMPORARY SUBSTITUTE during the policy period shown In the Deda-
AUTOS of SECTION 1 COVERED AUTOS, the rations, and must have been executed prior
following is added: to the "bodily injury or °property damage".
(2) This person or organization Is an 'insured"
If Physical Damage coverage Is provided by this Cov- only to the extent you are liable due to your
erage Form, then you have coverage for ongoing operations for that insured, whether
the work is performed by you or for you, and
Any "auto" you do not own while used with the per- only to the extent you are held liable for an
mission of its owner as a temporary substitute for a "accident" occurring while a covered "auto"
covered auto" you own that Is out of service be- is being driven by you or one of your em-
cause of its breakdown. repair, servicing, "loss" or ployees.
destruction. (3) There is no coverage provided to this person
BROAD FORM NAMED INSURED or organization for "bodily Injury" to its em-
ployees, nor for "property damage" to its
SECTION It LIABILITY COVERAGE A.I. WHO property.
IS AN INSURED provision is amended by the addition (4) Coverage for this person or organization
of the following: shall be limited to the extent of your negli-
gence or fault according to the applicable
d. Any business entity newly acquired or formed by principles of comparative negligence or fault.
you during the policy period provided you own
50 (g) The defense of any claim or 'quit" must be
96 or more of the business entity and the this person or organization as
business entity is not separately insured for tendered by soon as practicable to all other insurers
Business Auto Coverage. Coverage is extended
up to a maximum of 184 days following acquisi- which potentially provide insurance for such
tion or formation of the business entity. Coverage claim or "suit".
under this provision Is afforded only until the end
of the policy period.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services Office, Inc., 1997
CA 71 10 03 07 page m of 6 EP
REPRiNTW FROM THE ARCHNE. TmE OFdGINAL TRANSACTION MAY tXMUM AGOMONAL FOWS
(6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE
lesser of: A. SECTION III - PHYSICAL DAMAGE COVER-
(a) The coverage and/or limits of this policy; AGE. AA. COVERAGE EXTENSIONS, is
or amended by adding the following:
(b) The coverage and/or limits required by c. Personal Effects Coverage
the Insured contract". For any Owned "auto" that is involved in a
(7) A person's or organization's status as an covered 'floss', we will pay up to $5W for
`insured' under this subparagraph d ends "personal effects" that are lost or damaged
when your operations for that Insured° are as a result of the covered "loss", without
completed. applying a deductible.
EMPLOYEE AS INSURED EXTRA EXPENSE BROADENED COVERAGE
Under Paragraph A. of Section II - LIABILITY COV- Paragraph A. - COVERAGE of SECTION III -
ERAGE item f. Is added as follows: PHYSICAL DAMAGE COVERAGE is amended to
add:
Your 'employee" while using his owned "auto", or an
`auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen
In your business or your personal affairs, provided you covered "auto" to you.
do not own, hire or borrow that "auto". This coverage
Is excess to any other collectible insurance coverage. AIRBAG COVERAGE
FELLOW EMPLOYEE COVERAGE Under paragraph B. - EXCLUSIONS of SECTION III
- PHYSICAL DAMAGE COVERAGE, the following Is
Exclusion 5. FELLOW EMPLOYEE of SECTION II - added:
LIABILITY COVERAGE - B. EXCLUSIONS Is
amended by the addition of the following: The exclusion relating to mechanical breakdown does
not apply to the accidental discharge of an alrbag.
However, this exclusion does not apply if the "bodily
Injury" results from the use of a covered "auto" you NEW VEHICLE REPLACEMENT COST
own or hire, and provided that any coverage under
this provision only applies in excess over any other Under Paragraph C - LIMIT OF INSURANCE of
collectible insurance. Section III - PHYSICAL DAMAGE COVERAGE sec-
tion 2 is amended as follows:
* * BLANKET WAIVER OF SUBROGATION
2. An adjustment for depreciation and physical con-
We waive the right of recovery we may have for pay- dition will be made In determining actual cash
ments made for "bodily Injury" or uproperty damage" value In the event of a total loss. However, in the
on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to
Insureds" under Section ll - LIABILITY COVERAGE which this coverage applies. as shown in the
- A.I.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option:
A.I.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price
you paid for your damaged vehicle, not in-
PHYSICAL DAMAGE - ADDITIONAL TRANS- eluding any insurance or warranties pur-
PORTATION EXPENSE COVERAGE chased;
The first sentence of paragraph AA. of SECTION Ili b. The purchase price, as negotiated by us, of
- PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make, model and
follows: equipment, not including any furnishings.
parts or equipment not installed by the
We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership.
$1,50 for temporary transportation expense incurred If the same model Is not available pay the
by you because of the total theft of a covered "auto" purchase price of the most similar model
of the private passenger type. available;
Page 2 a 6
- R FROM THE ARCHIVE TKE ORiGDM TRANSACTION MAY aCLWE AW=NAI FORMS
c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen
not including any furnishings. parts or equip- property as of the time of the loss". less an
ment not installed by the manufacturer or adjustment for depredation and physical
manufacturer's dealership. condition; or
This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or
of the private passenger, light truck or medium lease that the damaged covered "auto" is
truck type (20,000 Ibs or less gross vehicle subject to at the time of the loss", less any
weight) and does not apply to initiation or set up one or all of the following adjustments:
costs associated with loans or teases. (1) Overdue payment and financial
TWO OR MORE DEDUCTIBLES penalties associated with those
payments as of the date of the
Under SECTION III - PHYSICAL DAMAGE COV- 'loss
ERAGE, If two or more "company" policies or cover- (2) Financial penalties imposed under a
age forms apply to the same accident, the following lease due to high mileage, exces-
applies to paragraph D. Deductible: sive use or abnormal wear and tear.
a. If the applicable Business Auto deduct- (3) Costs for extended warranties. Cre-
Ible Is the smaller (or smallest) deduct- dit Life Insurance. Health, Accident
Ibte it will be waived; or or Disability Insurance purchased
b. If the applicable Business Auto deduct- with the loan or lease.
able Is not the smaller (or smallest) de- (4) Transfer or rollover balances from
ductible it will be reduced by the amount previous loans or leases.
of the smaller (or smallest) deductible; (5) Final payment due under a "Balloon
or Loan".
c. If the loss involves two or more Busi- (S) The dollar amount of any
ness Auto coverage forms or policies un-repaired damage that occurred
the smaller (or smallest) deductible will
be waived. prior to the °total loss° of a covered
"auto".
For the purpose of this endorsement (7) Security deposits not refunded by a
Company" means:
lessor.
a. Safeco Insurance Company of America (8) All refunds payable or paid to you
b. American States Insurance Company as a result of the early termination
c. General Insurance Company of America of a lease agreement or any war-
ranty or extended service agree-
d. American Economy Insurance Company ment on a covered "auto".
e. First National Insurance Company of (9) Any amount representing taxes.
America (10) Loan or tease termination fees
f American States Insurance Company of
Texas GLASS REPAIR - WAIVER OF DEDUCTIBLE
Q. American States Preferred Insurance Under paragraph D. DEDUCTIBLE of SECTION 111
Company - PHYSICAL DAMAGE COVERAGE, the following Is
h. Safeco Insurance Company of Illinois added:
LOANILEASE GAP COVERAGE No deductible applies to glass damage if the glass is
repaired rather than replaced.
Under paragraph C LIMIT OF INSURANCE of
SECTION III - PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI-
the following is added: DENT, CLAIM, SUIT OR LOSS
4. The most we will pay for a total "loss" In any one The requirement in LOSS CONDITION 2.a. -
"accident" is the greater of the following. subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM,
to a $1,500 maximum limit: SUIT OR LOSS - of SECTION IV BUSINESS
AUTO CONDITIONS that you must notify us of an
CA 71 10 03 07 Page 3 o18 EP
REPRtN im moM TKE ARcmL uE omouu TRANSACTION mAAY =Lum ADW ONAL FORMS
'accident" applies only when the "accident" is known deductible and excess provisions. we will provide
to: coverage equal to the broadest coverage appricable
to any covered 'auto" you own.
(1) You, if you are an individual;
HIRED AUTO PHYSICAL DAMAGE COVERAGE -
(2) Apartner, if you are a partnership; or LOSS OF USE
(3) An executive officer or insurance manager, if you SECTION !!I -PHYSICAL DAMAGE A.4.b. Form
are a corporation. does not apply.
UNINTENTIONAL FAILURE TO DISCLOSE Subject to a maximum of $1,000 per accident, we will
HAZARDS cover toss of use of a hired "auto" if it results from
SECTION IV - BUSINESS AUTO CONDITIONS - an accident, you are legally liable and the lessor in-
82. Is amended by the addition of the following: curs an actual financial loss.
If you unintentionally fail to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE
Isting at the Inception date of your policy, we will not A. We will pay for rental reimbursement expenses
deny coverage under this Coverage Form because of Incurred by you for the rental of an "auto' be-
such failure. However, this provision does not affect cause of a covered "loss" to a covered "auto".
our right to collect additional premium or exercise our payment applies in addition to the otherwise ap-
right of cancellation or non-renewal. plicable amount of each coverage you have on a
covered "auto". No deductibles apply to this
HIRED AUTO -UNITED WORLD WIDE COVER• coverage
AGE
B. We will pay only for those expenses incurred
Under Section IV - Business Conditions. Paragraph during the policy period beginning 24 hours after
B.7.b.e(1) is replaced by the following: the "loss" and ending, regardless of the policy's
(1) The -accident" or `loss" results expiration, with the lesser of the following number
from the use of an "auto* hired for of days:
30 days or less. 1. The number of days reasonably required to
repair or replace the covered "auto. If
RESULTANT MENTAL ANGUISH COVERAGE loss" Is caused by theft, this number of
days is added to the number of days it takes
SECTION V - DEFINITIONS C. Is replaced by the to locate the covered "auto, and return it to
following: you.
•8odiiy Injury" means bodily injury, sickness or dis- 2. 30 days.
ease sustained by a person including mental anguish C. Our payment is limited to the lesser of the fol-
or death resulting from any of these. lowing amounts:
HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses incurred.
2. $50 per day.
If hired "autos" are covered 4autos" for Liability cov-
erage and if Comprehensive. Specified Causes of 0. This coverage does not apply while there are
Loss or Collision coverages are provided under this spare or reserve 'autos" available to you for your
Coverage Form for any "auto" you own. than the operations.
Physical Damage Coverages provided are extended
to "autos" you hire or borrow. E. If loss" results from the total theft of a covered
'auto's of the private passenger type, we will pay
The most we will pay for loss to any hired 'auto" Is under this coverage only that amount of your
S50A00 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which Is not al-
whichever is smallest, minus a deductible. The de- ready provided for under the PHYSICAL DAM-
ductibie will be equal to the largest deductible appli- AGE COVERAGE Coverage Extension.
cable to any owned "auto" of the private passenger F. The Rental Reimbursement Coverage described
or tight truck type for that coverage. Hired Auto Phy- above does not apply to a covered "auto" that Is
sical Damage coverage is excess over any other col- described or designated as a covered "auto" on
Iectible Insurance. Subject to the above limit.
Page 4 a 6
REP,"NTED FR0MTHE ARCKrje. 7KE 0MGDM TRANSACSIoH MAy 01CLUDE A OMONa FORM
Rental Reimbursement Coverage Form the manufacturer for the installation of a
CA 99 23. radio.
AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance
EQUIPMENT COVERAGE With respect to this coverage. the LIMIT OF IN-
SURANCE provision of PHYSICAL DAMAGE
A. Coverage COVERAGE is replaced by the following:
1. We will pay with respect to a covered 'auto" 1. The most we will pay for 'loss" to audio, vi-
for 'floss" to any electronic equipment that sual or data electronic equipment and any
receives or transmits audio, visual or data accessories used with this equipment as a
signals and that is not designed solely for the result of any one aaccident" is the lesser of:
reproduction of sound. This coverage applies
only if the equipment Is permanently Installed a. The actual cash value of the damaged
in the covered "auto" at the time of the or stolen property as of the time of the
loss" or the equipment is removable from a loss"; or
housing unit which Is permanently installed b. The cost of repairing or replacing the
In the covered "auto" at the time of the damaged or stolen property with other
loss", and such equipment Is designed to property of like kind and quality.
be solely operated by use of the power from
the "auto's" electrical system, In or upon the c. $1,000.
covered "auto". 2. An adjustment for depreciation and physical
2. We will pay with respect to a covered "auto" condition will be made in determining actual
for loss" to any accessories used with the cash value at the time of the loss".
electronic equipment described In paragraph 3. If a repair or replacement results in better
A.1. above. than like kind or quality, we will not pay for
However, this does not Include tapes, the amount of the betterment.
records or discs. D. Deductible
3. If Audio. Visual and Data Electronic Equip-
ment Coverage form CA 99 60 or CA 99 94 1. If 'loss" to the audio, visual or data elec-
ts attached to this policy. then the Audio, Vi- tronic equipment or accessories used with
sual and Data Electronic Equipment Cover- this equipment Is the result of a'loss" to the
age described above does not apply. covered "auto" under the Business Auto
Coverage Form's Comprehensive or CcM-
B. Exclusions sion Coverage. then for each covered "auto"
The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, return or re-
AGE COVERAGE, except for the exclusion relat- place damaged or stolen property will be re-
ing to Audio, Visual and Data Electronic duced by the applicable deductible shown In
Equipment, also apply to this coverage. In addi- the Declarations. Any Comprehensive Cov-
lion. the following exclusions apply: erage deductible shown in the Declarations
does not apply to "loss" to audio, visual or
We will not pay for either any electronic equip- data electronic equipment caused by fire or
ment or accessories used with such electronic lightning.
equipment that is: 2. If loss" to the audio, visual or data elec-
1. Necessary for the normal operation of the tronic equipment or accessories used with
covered pauto" for the monitoring of the this equipment is the result of a 'loss" to the
covered "auto's" operating system; or covered "auto" under the Business Auto
2. Both• Coverage Form's Specified Causes of Loss
• Coverage. then for each covered "auto" our
a. an integral part of the some unit housing obligation to pay for, repair, return or replace
any sound reproducing equipment de- damaged or stolen property will be reduced
signed solely for the reproduction of by a $100 deductible.
sound if the sound reproducing 3. If "toss" occurs solely to the audio, visual or
equipment Is permanently installed in data electronic equipment or accessories
the covered "auto"; and used with this equipment, then for each cov-
b. permanently Installed in the opening of ered "auto" our obligation to pay for, repair,
the dash or console normalty used by
CA 71 10 03 07 Page 5 o16 EP
REPRWTEO FROM T14E ARCHM, THE ORtd1 X TRANSACTM MAY MMUQE A00MOWL FORMS
return or replace damaged or stolen property SECTION V DEFINITIONS is amended by adding
will be reduced by a $140 deductible. the following:
4. in the event that there is 'more than one ap- Q. "Personal effects" means your tangible
plicable deductible, only the highest deduct- property that is wom or carried by you, ex-
ible will apply. In no event will more than one cept for tools, jewelry, money, or securities.
deductible apply. R. IYew vehicle" means any lauto" of which
you are the original owner and the "auto"
has not been previously titled and is less
than 365 clays past the purchase date.
Page 6 of 6
weft
vurchase Order
Fiscal Year 2017 Page: 1 of: 1
P_ ( ll~lll tIU,=MREAE-- ALL
FIIeM=G EW V MEN
B City of Ashland = -
ATTN: Accounts Payable Purchase
~ 20 E. Main Order # 603
Ashland, OR 97520
T Phone: 541/552-2010
O Email: payable@ashland.or.us
V LIQUIVISION TECHNOLOGY H C/O Water Division
E 711 MARKET STREET I 90 North Mountaiin Ave
N P Ashland, OR 97520
D KLAMATH FALLS, OR 97601 Phone: 541/488-5353
R O Fax: 541/552-2329
Vendor Phony Num6~r= Vnsi~r~ax L~lsamr~s- vier vn?GQ - ir-- erve -
800 229-6959 Steve Walker
- - - - = _
-DateOr~er~ __~ndQr~m= e~r~F3egUrr~-= -_-Fr~~g. = _ rrr-rs;
02/28/2017 423 FOB ASHLAND OR Cit Accounts Pa able
-14- W
_Item#- = -Ci'SECI _tiQnLwt_---- _ _
Crowson Reservoir
1 Clean and inspect Crowson Reservoir by divers 1 $3,500.0000 $3,500.00
Contract for Goods and Services Less than $25,000
Beginning date: 03/01/2017
Completion date: 06/30/2017
Project Account:
GL SUMMARY
L 081800 - 602400 $3,500.00
/ J /
Authorizedi ignature $3,500.00
t CITY OF
"R #3
ASHLAND
REQUISITION Date of request: 2-28-17
Required date for delivery: ASAP
Vendor Name Li
Address, City, State, Zip 711 Market St. Klamath Falls Or. 97601
Contact Name & Telephone Number Sherri Trigg 800-229-6959
Fax Number 541-883-1361
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 #
❑ VerballWritten 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
Clean and inspect Crowson Reservoir by Divers $3,500
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
Per attached quotelproposal $
Project Number ` _ Account Number - - P - - 9 = - ° -
Account Number----. Account Number 081800,602400
*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, 1 certify that the City's public contracting requirements have been satisfied.
Employee: Department Head:`~,~~~
(Equal to or greater than $5,000)
Department Manager/Supervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year: YES ! O
Finance Director m (Equal to or greater than 55.000) Date
Comments:
Form #3 - Requisition