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Home My WebLink About2007-256 Contract - Paul Nolte mm!'AP~N9~!J!:,.I,.A~YJ!:~m JS60 FISIII" J{O \1> J{OSlIlI"". 0111 "0' 97~70 law(a)ashlandhome.net October 11, 2007 Lee Tuneburg - Administrative Services & Finance Director City of Ashland 20 East Main Street Ashland, Oregon 97520 Re: Legal Review of the Solar Panel Request for Proposal (RFP) for the City of Ashland's Electric Department. Enclosed is the personal services contract for my work on items related to the Solar Panel Request for Proposal (RFP) for the City of Ashland's Electric Department. Also enclosed is the signed W-9 form and verification of professional liability insurance. f>~JJ~ Paul Nolte enclosures file #308. 170 C:\Law OfficelOO-jodylcover letter-ashland.wpd CI T Y OF CONSULTANT: Paul Nolte, Lawyer ASHLAND CONTACT: Paul Nolte 20 East Main Street Ashland, Oregon 97520 ADDRESS: 3860 Fisher Road, Roseburg, OR 97470 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (541) 821-2271 DATE AGREEMENT PREPARED: 10-2-07 FAX: (541) 672-2134 BEGINNING DATE: October 1, 2007 COMPLETION DATE: October 31, 2007 COMPENSATION: Hourly rate for this engagement will be $100 per hour not to exceed ten hours. SERVICES TO BE PROVIDED: Legal review of the Solar Panel Request for Proposal (RFP) for the City of Ashland's Electric Department. ADDITIONAL TERMS: None. FINDINGS: Pursuant to AMC 2.52.040E and AMC 2.52.060, after reasonable inquiry and evaluation, the undersigned Department Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein is fair and reasonable. NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as follows: 1. Findings I Recitations. The findings and recitations set forth above are true and correct and are incorporated herein by this reference. 2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, fumish all labor, equipment and materials required for the proper performance of such service. 3. Qualified Wonk: Consultant 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 service 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. 4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 5. Compensation: City shall pay Consultant for service 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. 6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract. 8. Living Wage Requirements: If the amount ofthis contract is $17,342 or more, Consultant 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 service work under this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 9. Indemnification: Consultant 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 Consultant (including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services attendant to this contract). Consultant 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. 10. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. Citv'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 Wl'itten notice to Consultant, 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. Iffederal 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 fundinQ proposed for navments authorized bv this contract; or Contract for PERSONAL SERVICES Less than $25,000 Contract for Personal Services Less than $25,000 - Page 1 of 6 iii. If any license or certificate required by law or regulation to be held by Consultant 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 Consultant 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 ofthe 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 Consultant's performance of each and every obligation and duty under this contract. City by written notice to Consultant of default or breach may at any time terminate the whole or any part of this contract if Consultant 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. Obliaation/Liabilitv of Parties. Termination or modification ofthis 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, cor d of this section, Consultant shall immediately cease all activities under this contract, unless expressly directed othel'J)/ise by City in the notice of termination. Further, upon termination, Consultant 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 Consultant for work performed prior to the termination date if such work was performed in accordance with the Contract. 11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 12. Assignment and Subcontracts: Consultant 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. Consultant 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. 13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; its ORF status pursuant to the ORF Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a ORF if consultant has qualified as a ORF 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. 14. Insurance. Consultant shall at its own expense provide the following insurance: a. Worker's Comoensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers. ($500,000 is the current amount.) b. Professional Liabilitv insurance with a combined single limit, or the equivalent, of not less than $500,000 for each claim, incident or occurrence. This is to cover damages caused by error, omission or negligent acts related to the professional services to be provided under this contract. c. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than $500,000 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 chanoe. 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 Consultant or its insurer(s) to the City. e. Additional Insured/Certificates of Insurance. Consultant shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only with respect to Consultant's services to be provided under this Contract. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work under this contract. 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 Consultant shall be financially responSible for all pertinent deductibles, self-insured retentions and/or self-insurance. 15. 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 Consultant 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. Consultant, 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. 16. 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 Contract for Personal Services Less than $25,000 - Page 2 of 6 THIS CONTRACT. CONSULTANT, 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. 17. 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. Consultant 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 Consultant, with no further liability to Consultant. Certification. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. ~yONSUL~ ~ f) i[nature n L U [;/1::. Print Name CITY OF ASHLAND: BY # FINANCE DIRECTOR/or other A ORIZED CITY REPRESENTATIVE LE~ n'</I€..d~~ Print Name and Tme DATE /4 ~2...- iJ TITLE DATE /0 /-t (07 Date: 1()1:J../0'7 City Business License # Federal 10 # ACCOUNT # 690.11.18.00.604140 (For City purposes only) PURCHASE ORDER # tJ 7 g 11 'Completed W9 form must be submitted with contract Contract for Personal Services Less than $25,000 - Page 3 of 6 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) 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. (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) 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. Contractor (Date) Contract for Personal Services Less than $25.000 - Page 4 of 6 FClm W-g Request for Taxpayer Identification Number and CertHlcation __to !he NqUeeler. Do not ...... 10 !he IRll. El.JIhlDlrwm..ltdhnilnt\'rcJr'n abaw. Indt.l1D:.llU &olio POP'" o OcrpDnslkW'l 0 PII1nnt1p D .arw.. nnmUumuu 0 =d:"bEtuP ~'n.niland"'''''(OptkInIIIJ 1lIx r ldolnlll'ication Number 1SI.......-~ <'(111I;8./. Enb!ryo" TN In the BpP'Dp1ebJ bOI.. The TIN provided must ITIIlch thB nlme gtlen L'fI Une 1 to lmJld bactcup wtthtIDldng. FcrlndMClUlIS.. U'1s. Is )'Our SOCIal sscurrJ nll11ber (SSN). HcNlo1W8r, tor. Mdlt'lt .Ien, SOleP.m, or Clsregsfd8:::I entity, Slab Pm Ilnsl:r1J'JtlOn& Cfl pege 3. Foro1h8renbttes,lI: Is l"uroIllllOI'" IllIIntmCllllon nlJ'llber (EN). W J'Ou do net h... . number. ... How io fill . l7N on page 3. Nota. tI' 'the 8CCOtl'lt IS In mol'& than cne name, M81ne 01'111: on page 4 fOr gldCIBlnea en whose numtJerlo enter. CerlllIoalion UndBrpenatUes Dr parJJry, I certtry1l1at: 1. 1l1e nunt:er shaMn oo1h1s. form IS ~ cornK:t tn.pAyer ldenUnC:.ltlon null'Der fIX I am nmng tlf a nUllber to ~ ISBtm to me), and 2. I 1m not Wbject to bICfOJp '6tthtoll1rtg. because: (8) I am eurn~ from b&::kup wnttlCldlng. a (b) I lUte not been ncttnfld ~ tha Intemll AlIMnUl sen'Q (IRS) thllt I am sutfed to ba::kup WII1nhOkl11"K.l as a ..ult Of a 1'1111.1'9 to report aJllnten1et or dlvti8ndSi. or (c11hB IRS I'Bi notllled ... tIiIIllm no longor "'~ect '" b!dOJp _tlOlc:lng. and a.. I am I U.S. peraan ondU:l~ B U.S. restJent alen), oerimcatIon Inatrucuou. You must cross QJt Item 2 lEoN If you NlWe been notmed I:1f 1ha IRS thl!t)'OO 8re CUrrently sLtlJec't 10 bEk1.41 ltltthhDtllrg ~::eJU t'IIll'e faled to rap:lrt allln1!feBt IInel dlVldeinClS on )'011' _ retlfm Fa I'M.I estata 1riI'IsactIons, ftem 2 daes not ~t.t. Far mortg&ge I . . pBCI; acqu.bn or st:erttlrrnent of BectJr&:j PR:JIert)', Clncelatlon or Cll1bt, contr1bubons to an Im:JlVldual natnmri BmIl1g1ment (1M), anel genenltt, ellt$ otnsr thin nterest 8~ dh1den:2S:, you are IYJt reqtJr81j 10 a1g1 h CerttncttlOn. but)'QJ muat plllVldo jOlI ccmoct TIN. (S" uotlone page "', Siln 81gnalUro of HIIH'8 U... on ~ Purpose of Form II ....- wilo loroqul19d to file m inI<lrrrnlIlon ......, wi1h tho IIl8. mllll oblaln yrM COO'oct 1l!rl<pIIyer ldon1lflco1lon number (flNI to report, i:>r ...."",., Incom. poId '" you. lOOi oe1>o -. rnongogo .._ you pold. ocqJolIlon Of _on! at ooco..rodpt'OpOl'1y. cancolllllion of d.bt. or OOI'IIributlon. you made to "" IRA. u.s. ......... U.. Fonn W~ only If you .... 0 U.s. poreon tncludrg a lOOident 0I1en). '" provIdo your C01'l'OCt TIN", 1110 penoon _o1Ing It (tIl. requ.otef) and. when oppl1cobl., to; 1. CertIfy thst 111. TIN you .....li/lring I. CO"""t (or you ore WIIithg for a runber to boo I8IL1OCO. 2. Cot1lfy 111m you .... not IUl:ject '" backup withholding. or 3. el8lm EI08mp1ion from bookup whhholding if you ..... . U.s.""""'PI_ III a _.If _-... you .... oleo OOf'1l!ying 1hst ... U.s. _n, you.oIlocobl. ohare of any ponn.....p Income from . US. _ 01' bUll..... I. not IUl:joct", the wilhholdlng t8x on foroign po"""'" .11<<0 of offocttmy _ll"IC'OmO. Not.. If a requester gives you Q brm other 1han Fam W-Q to roquoot your TIN, you must u..1I1o roqu"1>o". Ionn If It I. oUba1ontlolly e1m11ar '" thia f<nn W-Q. For f8demI taM. purpoeee~ you are considered a peracn it you """ .,...../0-(\-0 . hllndl'lldual wIIo I. . "Ill"", o. lOOi<lent of tho Unllod Sla.... · II ~p, ""'Po-, company. o. ....oi...n croo.lild <If 0I'lISI1z>0d In tho Unilod _. 01' urdor tho 10.... of 1ho Unilod1lta.... or . ,.,..,.- (o1llor thiln 0 "''''90 o-l or 1nJOt. See Reg_one _one S01.7101-li(a) and 7'(<ll for oddlllonol InfOrmation. lip.. ruIo. to< porlnonhlpe. Partn.....po 111m conduct a t_ 01' _.......In 1110 Url1lOd _ ...\I.......ny roqu!rod to .poy . M1hho1dlng "'" OIl any "'19190 ponnOlll' all... of _ from IUcI1_.. Fu_.1n oortlin _ who.... FOflTl W-o tu not b.en _. 0 poII'1I1.....p ia roqJrod to prolUll. _. l"lf1n.r 10 . ",...Ign -. end poy 1110nwi_lng \0>1. Th._. " you "'" a UA p....., """ I. a portner In . ps1norolip 00f1du<:t1ng . _ or bU"""'1n 1110 Unllilld Stoloo. provide Fenn w.O to 111. paI'tnOnlhlp '" ""'ablim your US. _ ond ....d wI1lTocIdlng on your aharo of portnerohlp Itwom.. ThopOlllOn wIIo give. Form W.Q to 1110 port....lllhIp for pu_ of o_oihlng 11. U.s. alaIuo and 8lIOicIlnfj wi_ding on 11>0 01_ __ of not income from..... port-p -_g ."""" o. buolnose Tn tho Unllod Slaw 10 In the following "....." · Tho U.s, ~r of a dlsregordod en1l1v end not 1ho onIity, Contract for Personal Services Less than $25,000 - Page 5 of 6 0Ii:. No, 1CG!31X FonnW"V(Rw.1t-lClC)$j CITY OF ASHLAND, OREGON EXHIBIT B City of Ashland . LIVING ALL employers described below must comply with City of Ashland laws regulating payment of a living wage. r.., 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 $17,342 or more. ~ For all hours worked in a month if the employee spends 50% or more of the employee's time in that month working on a project or _per hour effective .June 30, 200'7 (Increases annually every .June 30 by the Consumer Price Index) 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 $17,342. ~ 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. ~ Note: "Employee" does not include temporary or part-time employees hired for less than 1040 hours in any twelve- month period. For more details on applicability of this policy, please see Ashland Municipal Code Section 3.12.020. 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. Contract for Personal Services Less than $25,000 - Page 6 of 6 CITY OF ASHLAND OREGON STATE BAR PROF~SSIONAL LIABILITY FUND 2007 CLAIMS MADE PLAN DECLARATIONS Paul Nolte 3860 Fisher Rd Roseburg, OR 97470 CERTIFICATE NO. 691290 NAMED PARTY: paul Nolte COVERAGE PERIOD: January 1, 2007 through December 31, 2007 unless terminated by the Named party at an earlier date pursuant to PLF policy 3.400 RETROACTIVE DATE: September 1, 2004 LIMITS OF COVERAGE: $300,000 Aggregate / $50,000 Claims Expense Allowance as provided in Section V and Section VI DEDUCTIBLES: NONE Your copy of the 2007 claims Made plan is published in your 2007 oregon State Bar Membership Directory and on the PLF website, www.osbplf.org. please call us for a separate large print copy. WARNINGS This is a Claims Made Plqr. This plan contains prOV1Slons that reduce THE Limits of Coverage stated in the plan by the costs of legal defense. See Sections IV and VI of the Claims Made plan. various provisions in this plan restrict coverage. Read the entire plan to determine rights, duties, and what is and is not covered. PROFESSIONAL LIABILITY FUND 5335 5.W. MEADOWS RD. ,SUITE 300 P.O. BOX 1600 LAKE OSWEGO, OREGON 97035-0600 ~"''' r...", ,.......... .......,. ........,.. ..... ................... .. onn "1:'''1 1'::'0 -T r~' CITY RECORDER CITY Of ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541).488-5300 Page 1/1 07891 VENDOR: 010764 PAUL NOLTE, ATTORNEY AT LAW 3860 FISHER ROAD ROSEBURG, OR 97470 SHIP TO: Ashland Electric Department (541) 488-5354 90 N MOUNTAIN ASHLAND, OR 97520 FOB Point: Tenn.: Net R.q. Del. Date: Speclalln.t: Req. No.: Depl: ELECTRIC Contact: Dick Wanderscheid Conflnnlng? No LeQal Services - L9Qal review of Request for Proposal (RFP) for Solar Panels. 1,000.00 Compensation: $100 per hour/Not to exceed ten hours Contract for Personal Services Date of aQreement: October 2, 2007 BeQinninQ date: October 1, 2007 Completion date: October 31, 2007 BILL TO: Account Payable 20 EAST MAIN ST 541-552-2028 ASHLAND, OR 97520 SUBTOTAL TAX FREIGHT TOTAL ~~ .~ /~~~7 Au ed Signature VENDOR COPY A request for a Purchase Order REQUISITION FORM rG~1 ~ ~ ~un~ ~ CITY OF ASHLAND THIS REQUEST IS A: o Change Order(existlng PO # Date of Request: Required Date of Delivery/Service: 'P=.u-.\ "",\\-... ,L""",-",-<;"-v ~<;<\'D F:~_\-.....,.. R ,",<>...J.:. 1? (",c.....Q. ~~Lt..v2>' C'\\L. qr,i...l'r"'\(") t~~:5 ~~~ ~:~~4 Vendor NlII1e Add..... City, State, Zip Telephone Number Fax Number Contact Name soucrrATION PROCESS Small PnlcuIlllll8lll o Less than $5,000 o Quotes (OptIonal) InlIrmadIal8 ProcuIlllll8lll o (3) WrItten Quotes (CopIes attached) Reoullllt lor PIllIICIIII (CopIes on file) S_III/ EumDl o Written findings attached Quote or Pro attached E_ D Written findings attached Quote or Pro Ii attached o Copy of contract attached o Contract # Invltallon to BId (CopIes on file) Descrtptlon of SERVICES L....... ~\ ~,--...--' - ~~ ,^___v''''--~ '" 9,. ~ <= \ \U-c'-'-'->\- ~ \=0>-"-'>00:,<;'"",\",. ($\L~ Sc\o..y \----0..,<"",0- b ,\:: \-c~'<" ""'\- I,-.;:; ""'-..... ~ ~ \--.()~,<s.'J 0;;; attached PROPOSAl Item" Qu8ntlty Unit Description of MATeRIALS Unit PrI_ Totel Coat o Per attached QUOTE Project Number n____._n AccountNumber~'}9 Jl.1Z ''.!Q.1_c>_~!.~ 0 . //ems and setV/ces must be chatged to the appropriate account numbers for /ha "naOOa/s to reflect tha actual expenditures accul!Jtely. By signing this I8qUisition form, / carlify that the information provided above meets the City of Ash/and public conIIacting l8quirements, and the documentation can be provided upon l8quest. 1/ / I / Employee Signature: Supervisor/Dept. Head Signature: o/~ G: Flnance\Proc:edul8lAP\FonnslRequlsltlon Fonn.doc Updal8d on: 1012/2007