HomeMy WebLinkAbout2017-144 Contract - Automated Valve Services
Contract for G04DS AND SERVICES less than $25,000
CITY O F CONTRACTOR: Automated Valve Services ~AVS)
~S~LAND
CONTACT: Corey Booth
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 915 Merchant Street Redding CA 96002
Telephone: 5411488-6002
Fax: 5411488-5311 TELEPHONE: 530-243-4036
DATE AGREEMENT PREPARED: 5.30-17 FAX: 530-243-4396
BEGINNING DATE: 5-30-17 COMPLETION DATE: 6-30-17
COMPENSATION: Scope of services and fees attached as exhibit "C" not to exceed $4,999.00
GOODS AND SERVICES TO BE PROVIDED: Provide miscellaneous repairs to Ashland Water Dept.
automated valves when requested.
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 rima Ci of Ashland Contract.
NOVU 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 #his 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 2798.220, 2796.225, 2796.230, 2796.235, 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% ar more of the work under this contract. Contractor is also required to past 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
Contract for Goods and Services Less than $25,000, 0613012016, Page 1 of 5
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 far 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 na 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. Far 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 Subcon#racts: 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,OOO,OQ4 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:
Contract for Goods and Services Less than $25,000, 0613012016, Page 2 of 5
$200,000, $500,000, $1,000,004, 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 coverages) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional InsuredlCertificates 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 selfi 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, suitor
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 far 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
HEISHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY !TS TERMS AND
CONDITIONS.
19. NonappropriationsC/ause. Funds Available and Authorized: City has sufficient funds currently available and
authorized far 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.
24. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
By f By ~ k
Signature ~ Department ad
- -
Print Name Print Name
~ a ~ ~ ~
a
Title Date
W-9 One copy of a W-9 is to be submitted with
the si ned contract. Purchase Order No.
9
Contract for Goods and Services Less than $25,000, 0613012016, Page 3 of 5
EXHIBITA
CERTIFICATIONSIREPRESENTATIONS: 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 far 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 #o 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 } I 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.
~~4- (3) Telephone listing is used for the business separate from the personal residence listing.
.~t~' (4) Labor or services are performed only pursuant to written contracts.
~n,
~ (5) Labor or services are performed for two or more different persons within a period of one
year.
. (6) I 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.
i
Contractor ' (Date}
Contract for Goods and Services Less than $25,000, 0613012016, Page 4 of 5
j;-
3 ~ 3 f tj t~h....
ALJT~NiATEO \/'A LVE SERVlC~S !NC_
2017-2018 Rnte Sheet
Field Service Lnbor $75/hr.
Overtime is time and n half .
Prevailing wage rates if required nre ns follows.
Prevniling Field Service Lnbor $122/hr.
Prevailing wage overtime $153/hr.
Travel time $45/hr + $0.575/mile portal to portal.
Per diem is $50/day plus lodging per night.
s
Automated Valve Services 13877 Jody Ln. Bella Vista, Co. 96008
530-524-9725(cell)
AUTOVAL-01 RSARTI
~coRV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
0513112017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATNELY 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).
CONTACT
PRODUCER NAME:
George Petersen Insurance Agency -Redding i ~c°, No, Ext ; (530 244.9400 a~c, No ;(530) 244.9444
2920 Bechelli Lane E-MAI
Redding, CA 96002 I ADDR~ss: info@gpins.cam
INSURER S AFFORDING COVERAGE NAIC #
_ _ INSURERA:AtalnSpecialty Insurance Co _
INSURED INSURER B : Titan Indemnity Company _ 13242
Automated Valve Services, Inc, INSURER C _
13877 Jady Lane INSURER D : _
Bella Vista, CA 96008
~~INSURE~R E : _ _
INSUI RER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADOL SUBR ppLICY NUMBER ~ POLICY EFF POLICY EXP LIMITS
T N D 1 IYYYY MID YYY
A COMMERCWL GENERAL LIABILITY ~ EACH OCCURRENCE ~ $ _ 1'p~~'~~Q
CLAIMS-MADE X OCCUR CIP295332 ~ 10121!2016 1012112017 DAMAGE TO RENTED 100~QQQ
X ~ PREMISES Ea occurrence $
~ MED EXP An one arson $ 5,00
PERSONAL & ADV INJURY $ _ 1,000'00
GEN'L AGGREGATE LIMIT APPLIES PER: ~ GENERAL AGGREGATE $ 2,000'40
POLICY ~ Ei° ~ LOC ~ i PRODUCTS - COMPIOP AGG $ 1,000,000
OTHER: ~ ~ $
COMBINED SINGLE LIMIT 1,000,00
B AUTOMOBILE LIABILITY _(Ea accidents $
~ i
ANY AUTQ ~ 7417210 ~ 09109!2016 09!09!2017 gpDILY INJURY Per arson $ _ _
OWNED SCHEDULED ~ i
AUTOS ONLY X AUTOS I BODILY INJURY Per accident $
HIRED NON-0WNED i ~ PROPERTY DAMAGE
X ! Per accident $
AUTOS ONLY AUTOS ONLY !
$
I
UMBRELLA LIAR OCCUR ' EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE ~ AGGREGATE $
DED RETENTION $ ~ I $
WORKERS COMPENSATION ~ STATUTE i ~ ERH.
AND EMPLOYERS' LIABILITY Y 1 N ~
ANY PROPRIETOR(PARTNER/EXECUTIVE j~ i E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? ~ N 1 A
(Mandatory In NH) i E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
i i
DESCRIPTION OF OPERATIONS !LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, ma be attached 'rf more space is re uired)
THE CITY OF ASHLAND, AND ITS ELECTED OFFICIALS, OFFICERS, AND EMPLOYEES ARE LISTED AS ADDII~IONAL INSUREDS AS PER THE ATTACHED
FORM
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ZO E. MAIN STREET
ASHLAND, OR 97520
AUTHORIZED REPRESENTATNE
, ~d U
ACORD 25 (2016!03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
purchase Order
Fiscal Year 201.7 Page: 1 of: 1
5~[I~P -~1~1I~~~~~[~~1°gPPEALN_ALL:==
B 11~1~~~I1~~1~I~~~1~~1MENT~-_- -
City of Ashlar~~ - -
I ATTN: Accounts Nayable _ _ _
20 E. N1ain Purchase
L 763
Ashland, OR 97520 Order #
T Phone: 5411552-2010
p Email: payable@ashland.or.us
V H CIO Water Division
E AUTOMATED VALVE SERVICES INC I 90 North Mountaiin Ave
p 915 MERCHANT ST #6 P Ashland, OR 97520
p REDDING, CA 96002 T Fa~n541 552 23 Zg53
R p
V~n~orPhoneNumber--~/sndQri*a~Nu~e~=l~~.s~f~-----tor-~m - - ~ ~~i--~r~n~~" -
Steve Walker
_ _ ~ _ - _
-
Qate Ordered Vendor:l~t~_mb~r' ~~~e~qo-ir--~-----_-- ~h~t-sue- ~ orsn=--~a
0610612017 891 FOB ASHLAND ORINET30 Cit Accounts Pa able
_ _
_=1fem# = = - - -O -=__=C~s~rf ft~r~f~~~1 ~ =-..._._=~°R~~ E--~t~ri~~=d-Pr~ee=
Repairs to automated valves
1 Provide miscellaneous repairs to Ashland Water Department 1 $4,999.0000 $4,999.00
automated valves when requested.
Contract for Goods and Services Less than $25,000
Beginning date: 0513012017
Completion date: 0613012017
Project Account:
GL SUMMARY
081800 - 602400 $4,999.00
-
B ~ ~ ~ ~ Date: ~ ~
y _ e. _ ~
.Authorized Sig~~ature ~ _ = $4 999.00
FORM#3 CITY of
. ~ _ ~ ~ SHLAND
~
REQUISITION ~ ~ q 06/06/2017
Date of re uest;
Required date for delivery: ASAP
Vendor Name A1LtDl1latP UalvP ~arvire,S.(~]LSl
Address, City, State, Zip 915 Merchant Street, Reddi~ CA 96002
Contact Name & Telephone Number (530)243-4036
Fax Number
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption; ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMG 2,50 Date approved by Council; ❑ Written quote or proposal attached
❑ Written cote or ro osal attached _ Attach co of council communication _ If council a royal re aired, attach co of CC
❑ Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Date approved by Council;
® Direct Award 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 $15,000 ❑ 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 proposalslwritten 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
Provide miscellaneous repairs to Ashland Water Department automated valves when $4,999.00
requested
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quotelproposal $
Project Number _ _ _ _ _ _ ° _ _ _ Account Number 081800.602400
Account Number---°--°--°--'____-_ Account Number---°--°-_'---°-___--
~Expendifure must be charged fo fhe appropriate account numbers for the financials to accurately reflecf the actual expendifures.
IT Director in collaboration with department to approve all hardware and software purchases:
Ij Directory Date Support -Yes /No
By signing Phis requisifion form, I certify that fhe Cify's public confracfing requirements have been satisfied,
~ ~ ,'3
I q
De artment Head; ~a~~ s ~ ` ~ ` ~ i{ ~
EmNl~yee. N ~ .
(Eq I to or greater than $5,000)
Department ManagerlSupervisor: City Administrator;
(Equal to or greater than $25,000)
l
Funds appropriated for current fiscal year:. YES / NO
Finance Direcfvr= (Equalfo orgreaferthan X5;000) Dafe
Cornmenfs:
Form #3 -Requisition