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Home My WebLink About2003-056 Contract - Valley Electrical CITY OF ASHLAND (CITY) CONTRACTOR: VALLEY ELECRTICAL CONTRACTORS, INC 20 East Main Street Address: PO BOX 1555 Ashland, Oregon 97520 MEDFORD OR 97501 Telephone: (541) 488-5350 FAX: (541) 488-5311 Telephone: 541/773-1405 FAX: 770-2819 DATE OF AGREEMENT: MAY 5,2003 BEGINNING DATE FOR WORK: MAY 12,2003 COMPENSATION: NTE $2,140.00 COMPLETION DATE: MAY 30,2003 WORK TO BE PROVIDED: PROVIDE AND INSTALL ELECTRICAL SERVICES FOR CARDLOCK SYSTEM AT THE ASHLAND MUNICIPAL AIRPORT PER ATTACHED SCOPE OF WORK DATED MARCH 21, 2003. ADDITIONAL TERMS: CITY OF ASHLAND CONTRACT FOR WORK LESS THAN $25,000 CITY AND Contractor AGREE: 1. All Costs bv Contractor: Contractor shall, at its own risk and expense, perform the 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 all 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 workerlike 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. Comoletion Date: Contractor shall start performing the work under this contract by the date indicated above and complete the work by the completion date indicated above. 4. Comoensation: City shall pay Contractor for work performed, including costs and expenses, the sum specified above. Once work commences, invoices shall be prepared and submitted by the tenth of the month for work completed in the prior month. 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 and City shall not be obligated to pay any sum in excess of $25,000.00 unless a separate written contract is entered into by City. 5. Ownershio of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Reauirements: ORS 279.312, 279.314, 279.316 and 279.320 are made part of this contract. 7. Livina Waae Reauirements: If the amount of this contract is $15,000 or more, and Contractor is not paying prevailing wage for the work, Contractor must 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 must post the attached notice 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 approximately caused by the negligence of City. 9. Termination: This contract may be terminated by City by giving ten days written notice to Contractor and may be terminated by Contractor should City fail substantially to perform its obligations through no fault of Contractor. 10. Indeoendent 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. Contractor shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract and prior to commencing any work, Contractor shall provide City with adequate proof of workers' compensation coverage. Contractor is a subject employer that will comply with ORS 656.017. 11. Insurance: Contractor shall, at its own expense, at all times during the term of this agreement, maintain in force a comprehensive general liability policy including coverage for contractual liability for obligations assumed under this Contract, blanket contractual liability, products and completed operations, owner's and contractor's protective insurance and comprehensive automobile liability including owned and non-owned automobiles. The liability under each policy shall be a minimum of $500,000 per occurrence (combined single limit for bodily injury and property damage claims) or $500,000 per occurrence for bodily injury and $100,000 per occurrence for property damage. Liability coverage shall be provided on an "occurrence" not "claims" basis. The City of Ashland, its officers, employees and agents shall be named as additional insureds. Certificates of insurance acceptable to the City shall be filed with City's Risk Manager prior to the commencement of any work by Contractor under this agreement. These certificates shall contain provision that coverages afforded under the policies can not be canceled and restrictive modifications cannot be made until at least 30 days prior written notice has been given to City. 12. Assianment 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. BY Its SECRETAR TREASURER STEPHEN L. HILLS DATE 01)/19/01 Fed. ID # 93-0969315 OR Social Security # :~~s~~ CIty Administrator / or Finance Director CONTENT REVIEW: DATE: ;t.J,Nt. ~~ Acct. No.: CITY OF ASHLAND WORK CONTRACT <$25,000 (contract for work form 10-02.doc.docdoc) City Dept. Head) rchase Order # ~o. (J;{cc ..~C' "()l~ (for City purposes only) G:\pub-wrks\eng\dept-admin\AIRP\Fuel Tanks\Valley Electrical Cardlock Installation Contract.doc Uate: JILL/U,j U~:,j~ ANI .-::>enaers t-ax IU 1-~41-IIL-l ~Ub t-'dge I 01 I ACORD. CERTIFiCATE OF LIABILITY INSURANCE CSR KS I DATE (MMlDDIYY) VA!.LE-1 OS/22/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Protectors Insurance, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 514 Crater Lake Ave. AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 Phone: 541-773-5358 Fax: 541-772-1906 INSURERS AFFORDING COVERAGE INSURED IN::iURER A North Pacific Insurance INSURER B: Valley Electrical Contractors IN::iURER C PO Box 1555 INSURER 0 Medford OR 97501 I INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POUCY EFFECTIVE POUCY EXPIRATION LTR POUCY NUMBER DATE IMM/DDIYY) DATE (MMlDDIYY) UMITS GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 r--- A X COMMERCIAL GENEP.AL UABIUTY C08136775 01/24/03 01/24/04 FIRE DAMAGE (MY on8 Ilr8) $ 100 ,000 r--- tJ CLAIMS MADE [!J OCCUR f-- MED EXP (kef on~ p~"on) $ 5,000 f-- PER::iUNAL I$.I'J..JV INJURY $ 1,000,000 GENERAL AGGREGA TE $ 2,000,000 f-- I.;EN'l AUUREUA T E UMI T APPUE::i PER PRUOUCT::i - CUMP/UP AUG $ 2,000,000 I ril PRO- nlOC POUCY X .IECT AUTOMOBILE UABIUTY COMBINED SINGLE UMIT - $ 1,000 ( 00j) A ~ ANY AUTO C08136775 01/24/03 01/24/04 (Ea aCCident) ALL OWNED AUTOS ,/ - BODILY INJURY $ SCHEDULED AUTOS (per person) - HIRED AIJTO:, BUDll Y I!'>JURY - $ NON-OWNED AUTOS (Per aCCident) - -- PRUPEf-i 1 Y lIAMAI.iE $ (per dec"J."t) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ ~ NoN AUTI) OTHER THAN EAACC $ AUTO ONLY AGG $ EXCESS LlABIUTY EACH UCt;lJRRENCE $ ~ OCCUR D CLAlMS MADE AGGREGATE $ $ ~ DEDUCTIBLE $ RETENTlUN $ $ WORKERS COMPENSATION AND I ~gR~I~~~S I IlJi H- ER EMPLOYERS'LlABIUTY E L EACH ACCIDENT $ E l DISEASE. EA EMPLOYEE $ E L uISEA:,E. POLICY LIMIT .. OTHER DESCRIPTION OF OPERATlON5ILOCATlONSlVEHICLE5IEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Ashland, it's officers, employees and agents are additional insureds as respects to the operations of the named insured. CERTIFICATE HOLDER I y I ADDmONAL INSUIlED; INSU~EIl LITTEll; A CANCEL LA TION CITYAS2 SHOULD AHY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORe THE EXPIRATION DATI THERlO', THE ISSUING INSUREIl WILL ENDEAVOIl TO MAIL ...3.2.- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALl City of Ashland IMPOSE NO OBUGATION OR UABIUTY OF AHY KIND UPON THE INSURER, ITS AGENTS OR 20 East Main Street Ashland OR 97520 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I R. Joe Hubbard ACORD 25-S (7/97) @ACORD CORPORATION 1988 i.J . CITY OF ASHLAND, OREGON City of Ashland LIVING ALL employers described below must comply with City of Ashland laws regulating payment of a living wage. per hour effective ~une 30, 2002 ~.., (Increases annually every ~une 30 by the onsumer Price Index) Employees must be paid a living wage: ~ For all hours worked under a service contract between their employer and the City of Ashland if the contract exceeds $15,345 or more. employee's time in that month working on a project or portion of business of their employer, if the employer has ten or more employees, and has received financial assistance for the project or business from the City of Ashland in excess of $15,345. ~ For all hours worked in a month if the employee spends 50% or more of the ~ If their employer is the City of Ashland including the Parks and Recreation Department. In calculating the living wage, employers may add the value of health care, retirement, 401 K and IRS eligible cafeteria plans (including childcare) benefits to the amount of wages received by the employee. For Additional Information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it will be seen by all employees. G:\pub-wrks\eng\dept-admin\AIRP\Fuel Tanks\Valley Electrical Cardlock Installation Contract.doc CITY OF ASHLAND FROM SKINNER RVIRTION FRX NO. : 1 541 482 7681 ." I~:""~: h,'-_I.. I" iA 1.....1 ~L \""UI 1 r 1'.""1_ t u: I......J ,I 4..' ~ I~:U':" Ma~. 01 2003 07:59RM P5 I '-:u . er:n' li~.:! To: SkJnaer Avatiou VALLEY ELECTRICAL q'ONTRACTORS. INC. i t. ~ I P.O. Bo)( 1555 Medford, OR 97501 (541) 713-1405 Fax 770-2819 Mike Hamilton SCeve Hills CCB #65415 PROPOSAL , I ~-- 403 Dead India. Memo~l:Rd ~_;--_w. AsbJqd. Or 91!ZO ! A TrN1 Bob Sidener Valley EI~~tru;iJl Contrac~ors, Int.! P"OPOS9S to furoist', the labor Ol't m~t9r:als; 10 accoml'iiSh !t':~ fO!Jowi.,g~ I I (G~"Gr~ I DescriptiO., Of Wl)rk] ! ELlCTRlCAL BID PROPOSAL i. 1"&Ull & W~~ Catto..er Suppled Card uClk System To (2) Fuel Dbpcasen in ~dA~rt I -II - ~$tte 01 wotkJ fer th~ CCimpensallon ~S follows: I : S2'~.OO I f I Two Tllousand 0.. BUl'ldred J'anrty And OO/lot ! ' The proposal is ba~d upon J~~!mated Q",anti\;es for the work !lS ~o!lowt: I PROVJl)E "INSTALL l' coudllk at IIttinp to g~ tslstine raceways PROVIDE,. INSTAU wiring required per dmdnC I PROvtDE " INSTALL powdtr coated adapter hue { . PROVIDE'" INSTALL I. iacltadet (2) boars f'AJ1" syatem atan-up" PROVIDE !'. permit. I" the event il)s project &twll ~.t.~ v,,"O"< ir;-ex=c~s of ftll!l q~itiell 8b01l8 set Qut. and If thi!:. is a lump &urn proposal. ell:tr,a charges ~aU be made ror such add!t~t1lf WO~ ~ t!'le rates !her. being regulany ct1argi!c by the I.mderslgnea for slJd'1 it~ms. Pavmem &hall be due on or be~re 10 drJye after O~~"g fo(kJwing ~Iefjon of tl'le wofl(. Tile par:y pN!lIailing in a~~ litigatJOtl at'l$i1'\Q OUt of t.~A WOI'k, Cl" th ~iagreer"flen1. 6"al be e~titled to ro~""$f &ucn SJf"l'l as tf\e court m3Y ~judO& M3GOt1;ble Ie etto\"l'leY; fees in li~g81l0n. ! la~ cNlr~: c( 1 ~% per mor+1 {18% ,nnu151 peroent:ige rme} will be ctlDrged Qrl ICl:QUr!t5 n()t p~id wi1t1k1 30 day~ fOllowing joo comp:etlcr. date. i I . i SDeoa! conditions: I : MATE~" LABOll - (TO BE INSTALLED DURING kEOVLAR HOURS) I ..~: EIJstiag ecntduJU.a. be readUy acectulble & Kseable .. *; Exclude proaram log Ind let-Gp , Th' _L ; 30 1$ proposal is mada fol' aeceVjl.~nce within_.........dsys only Of ths date ~.,;"tof. Oat~d U'li5.-.!Lday of MA~+-_. 21;J~ ! VA~IiY IiLILCTRICAL CON~AACTORS~ INC. I . AccePTANce: 'J'he fOr$going proposa./ II "Q~$ptOd \his ...... 'I . tiey of . !O____ I SV _...........__..__ ; _ fig,. '1Ifh.J, IWIlt6tb'iI, '"It .mI ret&IM 10 v*., rffJe'~ Casn"-ttort. lftc, "'.fofbi d41plkt'. (yellow) '.-----11I---- ~m.tor FROM SKINNER AVIATION FAX NO. 1 541 482 7681 Ma~. 01 2003 07:57AM P2 August. 21, 2002 Quote #1.15825 Page 1 of 4 Bob Skinner Skinner Aviation 403 Dead Indian Memorial Ashland, Oregon 97520 Re: Cardlock System Dear Bob, Thank you for your inquiry. information: We are pleased to p~ovide the fOllowing pricing FuelMas~er ~ical ~~iation Site with Smartcard 1 The FUELMASTER 2560 series cardlock for Aviation, includes: $9,795.80 $9,795.80 . FMU-2560 (Controls 2'HoBes, with Modem & Surge Protection) PRP-2500 Pedestal Receipt Printer Fuelrnaster Windows software (for PC) QSE Quick stop Button TP-2500, On-Site serial Transaction Printer . . . . FuelMaster ODtions Pack&ge Package to include: . To add a third product to the FuelMaster cardlock please add $195.00 to cardlock system total. Optional addition of "Smart Cards" to system for non network fuel sales please add $660_00. This will include 50 cards and the encoder. . SedItIe. Washino/m 1143 Elliott AVI W, 98119 P.O. Box 9Cl39. 98t~ t061Z81.S000 Fox 206/281.5030 POllllwl.~ 5107 ME 15Bth Ave 97230 503m2-20ll0 Fa~ S(l3n52-2226 ~fI6k/ln., WalJ.inll'Ql'I 651 B E IMn Ava 99212 SU9!536-H3~ Fall 509/536-4345 FROM SKINNER AVIATION FAX NO. 1 541 482 7681 .... Bob Skinner August 2J., ~002 Quot~ :tt1.l5825 Page :2 of 4 Site Electrical & Installation 1 This package will provide electrical for equipment listed in bi~_ This is being provided by our sub-contractor and will include the following: . I have confirm@d tnat the dispenser have pulse~s on them but they are 10;1 puls~rs not lOO:l pulser which we normally use when re-selling to the public. I have confirmed with ~uelMaster that 10:1 will work but if for some reason you want lOO~l they will be ihstalled on a time & material b~sis. The electrical & install quote is based on what we could see while at the site. If any of the underground portion of the condl.l~t is bad we will need to ~eplace this and we will give you a bid at that time. FuelMaster Card System Start-Up Packaq@ 1 This package will include having a factory trained technician review wiring necessary to hook into the FuelMaster card system. We will then start-up the card syst@m and train you on system functions. We will also train yo~ on the windows based software if it is il1l';:luded with the system you purchased. Package includes: . 1St day(8hrs): Travel to wiring inspection w~th Overnight at site. 2nd day (6hrs) Do startup with system operator. 3rd day (8hrs) Finish up travel back to office. site and do electrican. . and training . t;t"aining and Ma~. 01 2003 07:58AM P3 $4,500.00 $2,206.00 $4,500.00 $2,208.00 FROM : SKINNER AVIATION FAX NO. 1 541 482 7681 Ma~. 01 2003 07:58AM P4 Pacific Electrical Contractors P{lcific Electrical COnlr(1r;tors, Inc. 920 S. GrapE~ Street, P. o. Box 1430 Medford, Oregan 91~{)J Phone 541.111.1151 F(1)( 541-?19-l072 www.p(lr;ifiC'elecrrical.tom PROPOSAL TO~ Ashland Municipal Airport c/o Skinner Aviation 403 Dead Indian Memo~~t1 Rd. Ashland, OR 97520 ' JOB NAME: A. T. Model 3000 Card! Reader JOB LOCATION: Fuel Island Pacific Electrical Contractor's, Inc. p,roposes to furnish labor and materials for the work shown on the electrical _dr~,#in~s N/A, s'pecifici:!~ons N/A,.~.~dendum N/A,..dated NJA, and include.s the.~~lIowi.ng~. 1) Install concrete footing on i~land with powder coated adapter plate. 2) Install model 3000 pedestal and connect existing conduits with explosion proof flex and seal offs to pedestal barrier. 3) Install proper wiring and tertninations between dispensers, relay panel and pedestal. 4>. Test aU functions.. TOTAL PROPOSAL: $3,225.00 SPECIAL CONDITIONS & EXCLUSIONS: Additionill components if not compatible. Electrical permit cost. TERMS AND CONDITIONS: 1) All workmanship and materials are t<(l comply with the requirements of the National Electrical Code; and the applicable local and state eades. . 2) This proposal is based I.lpo11 a lump ~um unless otherwise noted. Contractor shall bill on 3 monthly basis. Payment is due within 10 days of the monthly Invoi<fe. Sums not paid within said time periOd Shall accrue interest at th$ rate of 1.5% per month from the date of the invoi~ until paid. If there Is a retainage option required by the owner, it will not exceed 5% withheld. In the event a party retains! an attorney to enforce any of the terms of this proposal, or any other contract .document executed in connection h~r'Etwith, the prevailing party shall be entitled to. r.ecover attomeys~ fBes and costs ....---iRc!:lfred'-wh~thel"..:'Y.:"!C't.l1t!gat:on is ti!ed; and !I"! the event litig2t!0r! Is flied, ~e prev:;li1ing party s.~1I ~ tmtitled to recover attorneys' fees and costs incurred in saiq Iiti~3tion at trial and on appeal. . . 3) Contractor shall not be lIabla fot a'1Y charges for tempot3ry wiring, electrical energy, heat, job telephone. garbage disposal seNices. etc. unless otherwise /Stated in this proposal. Contractor shall not be liable for any Charges for liquidated dama~es resulting from delay in compl~tion of the work caused by f"ctors beyond hislher control. ~roject schedule and completion to be mutually agreed upon prior to beginning work. PACI~lC ELECTRICAL CONTRACl!ORS, INC. cee #3651 BI(. .John Elbon~ ' Title Service Manaaer .... ./ I,. ,. .' '. . . ,,' ", '. This proposal'is 'made for acceptanoe within 30 days. Date 3/19/03 ACKNOWLEDGED AND ACCEPTED ~ ~h ~~ Signater IN3rr'3nf$ thet he/she is authorized to enter into contractual agreements. CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 CITY RECORDER'S CO~y DATE OS/29/2003 VENDOR: 006373 VALLEY ELECTRICAL CONTR. INC. POBOX 1555 MEDFORD, OR 97501 FOB Point: Terms: Net Req. Del. Date: 05/12/2003 Special Inst: Descri tion BLANKET PURCHASE ORDER Provide and install electrical services for cardlock system at the Ashland Municipal Airport per attached scope of work dated March 21, 2003. CSK Date of Aqreement: May 5, 2003 Beqinninq Date: May 12, 2003 Completion Date: May 30, 2003 Insurance required BILL TO: Account Payable 20 EAST MAl N ST 541-552-2010 ASHLAND, OR 97520 SHIP TO: Ashland Public Works (541) 488-5587 27-1/2 N MAIN STREET ASHLAND, OR 97520 Req. No.: Dept.: PUBLIC WORKS Contact: Paula Brown Confirming? No Unit Price SUBTOTAL TAX FREIGHT TOTAL PO NUMBER 04188 Page 1 / 1 Ext. Price 2,140.00 2 140.00 0.00 0.00 2,140.00 Account Number Amount Account Number Amount E 280.08.00.00.602320 2,140.00 -- - - /' ... ~a y - . & {-=---- "- VENDOR COpy Authorized Signature CITY OF ASHLAND NOTICE OF TRANSMITTAL TO: KARl OLSON PURCHASING DATE: PROJECT: JOB NO.: SUBJECT: MAY 22, 2003 CARDLOCK INSTALLATION CONTRACT DOCUMENTS THE FOLLOWING ITEMS ARE BEING SENT TO YOU: Please find attached one original fully executed contract for the Cardlock Fueling System Installation at the Ashland Municipal Airport. A requisition is also attached for this project. ENCLOSED ~ UNDER SEPARATE COVER REMARKS: COPIES TO: Department of Public Works By: Dawn LantYtJ1 Title: Administrate ~sistant PUBLIC WORKS 20 E. Main Street Ashland, OreQon 97520 WWW.aShland.or.us G:\pub-wrks\eng\dept-admin\AIRP\Fuel TanksWalley Electric Carlock Contract Purc NOT.doc Tel: 541-488-5587 Fax: 541-488-6006 TTY: 800-735-2900 r... ., CITY OF ASHLAND REQUISITION No. PW 142- FY 2003 Department Public Works Vendor Valley Electrical Contractors Inc. PO Box 1555 Medford OR 97501 Account No. 280.08.00.00.602320 Date May 22, 2003 Requested Delivery Date Deliver To Via Paula Brown ASAP Dawn Lamb (* Note: Please allow approximately two(2) weeks for delivery on items not generally caried in stored, and approximately two (2) months on printing jobs.) Item No. Quantity Unit Description Use of Purchasing Office Only Unit Price Total Price PO No. Contract for the installation of the cardlock $ 2,140.00 feature on the fueling system at the Ashland Municipal Airport. TOTAL $ 2,140.00 for Kari: BID /RFP I EXEMPT: bid Contract Start Date: May 19,2003 Contract Completion Date: May 30, 2003 Insurance on file: , YES I NO Project No: N/A Job No. Unit No. I hereby certify that the above items are necessary for the operation of this department and are budgeted Issued By Date Received By r~'