HomeMy WebLinkAbout2010-125 Contract - A to Z Home Improvements
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Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: A to Z Home Improvement
ASHLAND CONTACT: Scott Stranahan
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 3495 Randall Avenue, Central Point, OR
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-301-0207
DATE AGREEMENT PREPARED: Julv 28,2010 FAX: 541-826-4895
BEGINNING DATE: Julv 30, 2010 COMPLETION DATE: October 30, 2010
COMPENSATION: Not to exceed $5,000. Per attached proposal #1301, dated July 23, 2009.
GOODS AND SERVICES TO BE PROVIDED: Brush Clearing and Vegetation Removal - Work to be
oerformed on an as-needed basis. ADDITIONAL TERMS: Workers' CompensatiDn insurance is being waived because tnscDntractor has no
employees and he will be performing the work himself. Contractor initial '7
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NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mu'tual 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 2798.220, 2798.225, 2798.230, 2798.235, 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 $18,703 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 8 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, 5ubrogations, 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
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If Citv fund inn from federal, state, countv or other sources is not obtained and continued at levels
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 1 of 5
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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 exciusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obliaation/Liabilitv of Parties. Termi.nation 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.11 0 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 ORF status pursuant to
the ORF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
ORF if Contractor 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.
16. Insurance. CDntractor shall at its own expense provide the following insurance:
a. Worker's ComDensation insurance in compliance with ORS 656.017, which requires subject employers to
provide OregDn workers' compensation coverage for all their subject workers
b. General Liabilitv insurance with a combined"single limit, or the equivalent, of not less than Enter one:
1$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable fDr each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
c. Automobile Liabilitv insurance with a combined single limit, Dr 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 chanae. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance cDverage(s) withDut 30 days' written notice from the Contractor or its insurer(s) to
the Citv.
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 2 of 5
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e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected Dfficials, officers and employees as Additional Insureds on any insurance policies 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 Df Oregon without resort to any jurisdiction's conflict of laws, rules or dDctrines. 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:
30hl"'
By I//l g C# rr- 51/2/1,11/ ,4-I{/'fA/ By
Signature
4lr-~ ~
Print Name
Print Name
@vu.--~
Title
'1- 29 - I 0
Date
W-9 One copy of a W-9 is to be submitted with
the signed contract.
Funds appr~d r current fiscal year: d'I '/ t!)
Finance Director Date
Approved as tD form:
Purchase Order No.
Legal Department
c:fJJI'l ,#--- (
Date
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 3 of 5
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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:
l/ (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.
f-.- (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.
l/ (4) Labor or services are performed only pursuant to written contracts.
V (5) Labor or services are performed for two or more different persons within a period of one
year.
t /' (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.
//7f., ~ c.-/-
Contractor
7---;2c;--to
(Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 5
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PROPOSAL tl13D1
\ t.o :II HOME IMPROVIlMEl'ITS '
496 RANDALL AVENUE
:ENTRAL POINT, Ofl.EGON.
:COTl' STRANAHAN
'H # (541}301-D207 "AX # (541) 826-4895
.le# OR, 173052
;Ity Of Mhland
'urchaslng Represetative I Kari Olson
10 N M.ountien eve
\shlan'd Oregon 97520
'ax # (. 54'f') 488- 5320
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DESCRRIPTION OF WORK LISTED BELOW;
tern
BRUSH CLEARING AND VEGETATION REMOVAL
We propose to supply the equipment and labor
necoilssary, to clear brush & vegetation
Residential & CQmmerCial
/1.
-1
, 2.
Tax lot size 50' x 100' (or 5,000 square feet)
Tax lot size 100' x 100' (or 5,001 to 10,00D sq ft. )
~3.
---t
Tax lot size 1/2 aera ( or 10,001 to 21,780 sq ft. )
~4.
Tax lot 1 acre and larger, per acre ( 21,781 to
43,560 sqft. )
...\
~ 5.
Tax lot I hill side requiring self propelled equipment
TRACTOR FIELD MOWING / FIRE BREAKS
fl!1.
1 to 5,000 square feet
fl!.2.
5,001 to 10,ooD square leet
#3.
1D,001 to 21,780 square feet
#4.
21,781 to 43,560 square Teet
#5.
Special rate for hand work.
~!/- .2-
HOURl. Y TOTAL PRICE
$48. 98 $146,94
$48.98 $195.92
$48.98 $293.88
$48.98 $391.84 ,
$74.98
\
$59.98 $119_98
$59.98 $149.95
$59.98 $179.94
$59,98 $239.92
$24.98
Sd W~L~:60 600G ~G 'Inr
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A to Z HOME IMPROVEMENTS: Operated as a sole proprietor
ASHLAND BUSINESS LICENSE: N/A at this time
CAPAl3lUTY:
1.( 2005 ) 40 horse four wheel drive tractor with 6' bush hog / rotary mower
2. self propeted lawn mowers, 2 weed eaters, 1 walk behind weed eater
1,2000 gmc pic:l< up 1, 6'x 12' utility trailer hand tools ect--
AVAILAl3ILITY:
4 days a week 8 hours a day
INSURANCe:
Generalliabilily & Auto liability available within two business days
REFERENCES / MOWING CUSTOMERS FOR; A to Z HOME IMPROVEMENTS
CLYDE SEVERSON, PH #- (541) 779-7196
MIKE BA~R, PH # (541) 482-2510
JIM POST, PH # (541) 779-4102
Sincerely Scott stranatlan
:L P'.t.I- ~
vd W~9~:60 600c ~c '!nr
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... :or; nOME IMPROVEMIENTS
196 RANOAl.L AveNUE
eNTRAL PqINT, OREGON.
:::orr STRANAHAN
,. tt. (5411. 301-020'1 FAX. # (541) 826-4896
C# OR. 173062
PROPOSAL # 1301
Ity Of Ashland
Lltchaslng Represetative I Karl Olson
) N M,ountlan aye
"hlan'd Orugon 97620
ax # ( 641") 488- 5320
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DeSCRRIPTION OF WORK LISTIOD BIOLOW;
am
BRUSH CLEARING AND VIOGETATlON ReMOVAL
We propose to supply the equipment f:\nd labor
necessary, to clear b~$h & vegetation
Residential & Commen$al
~5.
Tax Jot / hill side requiring self propelled equipment
HOURLY TOTAL PRiCe
$48.98 5146_94
$48.98 $196.92
$48.98 $293.88
$48.98 5391.84 ,
$74.98
, 1.
'-,
\2,
Tax lot size 50' x 10D' ( or 5,DDO square feet)
Tax lot size 100' x 100' (or5,001 to 10.DOO sq ft.)
~ 3,
o
Tax lot size 1/2 acre (or 10,D01 \021,780 sq ft. )
'4.
Tax lot 1 acrG and larger, per acre ( 21,781 to
43,56D sqft )
TRACTOR FIELD MOWING I FIRE BREAKS
11.
~'2.
J3.
~ 4.
-
11'5.
1 to 5.000 square feet
5,001 to 10,000 square feet
$59.98 $119.98
"
$59.98 5149.95
1D,D01 to 21,78D square faet
$59.98 5179.94
"
21,7811043,560 squareleel
S59.Be 5239.92
Special rata for hand work.
$24.98
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. . OERTIFICATE OF LIABILITY INSURANCeI0a180511onolOJ
Produc.", This C:O:l:lieablls Issued as a matter of Information only .
and con eM no r1ghtB upon lt1e cerJifiea18 holder, This
J~tne. A H.tton In""""''''' Agotlcy certlfiea'" d""" net In any way amend extend or 8""r
i2&lf;~dl~ Rd. Suit. H 111& coverage pro\/ldOd by the polley lI.lad below.
Medford, OR 97504 Companies Al'lordlng Covorago
~41.773.3413
Lie<>.,e: CA 006022 A Navigators IllSmance CDmpany
.
InslIred: B Farme,rs
Michael Scott StrSnahan
A to Z Home Improvements C
3495 Randall Ave -- -
Central Poin~ OR 97S02 0
COvGl'Ilaaa:
Tnls Is to <.rtlly that iFe"iiollcy ler lh3 obove named Insure" oa. ""en is.u.d to lhalnoured ".mod ebovEifoitli. polioy period indicated,
~ notWithstandIng any re~ulremel'\t, term or oond:tion afmy eontraot or Clther t1QCument witM respect 10 which this certmeats may be isaued
or may p&l'!ain. ThOI"sur."".. _<<orded by tte policy described herein Is subjeclto all loe !elmS, exdusiOl1S end con<l"lono of ouch policy.
~ !.in..:shawn may heve bean red"ced by paid olaim..
B Type of Inaurance PolicI' ~umbe' -f-J.fIe~t!w e'''ll'Iltlon Limil$
General Uabllity , Bodily Injury Cec.
a II CompreoMsive Form 3610108157 102/0312010 0210312011 -'-
Premi$eWOperations i:!Qdlly injury Agg. '-----.----.-
,
o UndA\i",und E~"''''ons I Propeny Dmg. 000,
& Col pee Hoz rd Property Dmg. NIS. ~,,~..,---
~ ProduclslCOmpleled Opo , ! el '" PD CSL Cec,
Contractual $1,000,000
IndOll. COnlmCtors 6i"'i'PD CSl.Agg_ \>2,000,000
B .-...........------.- -----
Broad Form Prop Damage Porsonallnl. Agg.
Personal Injul'Y --......,..
-
Auto Liability Bodily Injury/Petsn:
b o Any Auto
~ AU Owned (Priv. Po..) Bodily InjurylOcc.
o An Owned Aulos I -. --
(othertlw'l PrIv. PaiS.) I Property Damego
o Hired AIJ1cs i 149885210 09lJOt2010 09/30120 II
o No".l).o;nO<l Single Urn" Liability:, $500,000
o Garege l.Iabnlly - --
0 Cargo Cargo ~9oh V9h.
Cargo Each 0Cc.
Wor mpenaation I we SlaM.ry Urn. "WallY.
and Employe",' Liability fl.. ef:ldlaccitten1 ,.--
'ThQ Pfl)pMQtl)ff p;rtMn;/ EL Dise... . Urn! .
D~utiv& {)ffioem n~
Indudtd E><duded ....... ....'sea5e 'O:'Q elllfJla~ --
~enption 01 OIltr.ti"".A.Oea1;o",Nel1i~l$p'MIIl.m..
CertLf'icat e Holde;!;' J.s also an additlona.l Insured
Certificate Holder -
<;ancellatlon:
Ci ty of Ashland Should any Df1he above policies- be C;::jUlCV~to tho Q~tltfon dlitel
20 E Main St the issuing CXllTlpany wHI endesvorto mail days wrl n notice to
Ashland Or 97520 the certtflcat:!!I holder named to thlJ left, but failure to mail tueh notioe
shall Impose no obligation or llabllity or any kind upon the ctYnpany. Its
r repres ....
( Auth7r ~ -
-- ,. I
/l,ES Agency BuUder .. to Agincy Su~b'lQU SyutQmt. /'
~
Page 1/1
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. C I T Y 0 F CITY RECORD~
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
'DATE"
8/2/2010
;;." pO'NuMBER:""
09721
VENDOR: 014573
A TO Z HOME IMPROVEMENTS
3495 RANDALL AVENUE
CENTRAL POINT, OR 97502
SHIP TO: Ashland Fire Department
(541) 482-2770
455 SISKIYOU BLVD
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.:
Contact: Margueritte Hickman
Confirming? N~
:IQiJa'ntlfv"', ,YUn-it'::~ i':"';"."",,,: '.:"; 'c:. 'b'e:i:fcflDtion '. ,..\,<, ,,:'.,,',~ . .':UhitF'i1c~; ."., '/-" 'Ext:,-~'riCEj",.;, '-':!~,
t", .. ..
Weed Abatement .. Per attached contract 5,000.00
- Not to exceed $5,000
Contract for Goods and Services
Beginning date: July 30, 2010
Completion date: October 30, 2010
..
SUBTOTAL 5000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 5,000,00
ASHLAND, OR 97520
;~!f~:'A'Cco'untNllmDe'im{ift.:;jJ '~I};:groje'ct~N'umber~ ,'~ ~. -.". Amo'l.lnf'::L ,'.1' ::",~ .. Accoun(NU'nlber',;.:, . 'i' ,,' :C~roject).j'lmii)eri.;;~itiJ ~~~Y~mo.unt~
:~ ,ii-
E 1 10.07.51.00.61050 E 000210.999 5 000.00
~ -1 L ~~cJ
Auttfd"rized Signature VENDOR COPY
.'
CITY OF
ASHLAND
t.
A request for a PUichase Order
REQUISITION FORM
Date of Request:
07-29-2010
THIS REQUEST IS A:
D Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name
Address, City, State, Zip
Contact Name & T etephone Number
Fax Number
A In 7 Hnmp. Imprnvp.mp.nl~
Scott Stranahan
541-301-0207 or 541-826-4895
SOLICITATION PROCESS
o ExemDI from ComDelllive Biddinq o Ememencv
Reason for exemption: o Invitallon 10 Bid (Copies on file) o Written findings attached
Oate approved by Council: o Quote or Proposal attached
~, Small Procuremenl Coooerative Procurement
oss than $5.000 o Requesl for ProDosal (Copies on file) o State of Oregon
Note: Total contract amount, including any Oate approved by Councii: Contract #
amendments may not exceed $6,000 o State of Washington
Inlennediale Procurement 0 Sole Source . Contract #
GOODS & SERVICES 0 Written findings attached o Other govemment agency contract
$5.00010 $100.000 0 Quote or Proposal attached Agency
o (3) Written quotes attached Contract #
PERSONAL SERVICES 0 SDeclal Procuremenl 0 Intergovemmental Agreement
$5,000 to $75.000 0 Written findings attached Agency
o Less than $35,000, by direct appointment o Quote or Proposal attached Contract #
o 131 Written oroposals attached Oate aooroved bv Council: Date approved by Council:
Description of SERVICES
Total Cost
Weed Abatement
Brush Clearing
Vegetation removal
As per contract not to exceed $5,000.00
Item # Quantity Unit
As Per CDntract nDt to exceed
$5,000.00
Description of MATERIALS
Unit Price
Total Cost
D Per allached QUOTE
TOTAL COST
$ ,
Project Number 000210.999
Account Number 110.07.51.00.610500 Account Number
. . . .
--- -- -- -- ----~-
Account Number ___' __' __' __' ______ Account Number ___' __ - __ - __' ______
'Expenditure must be charged to the appropriate account numbers for the financials to refiect Ihe actual expenditures accurately, Attach extra pages if needed,
By signing this requisition form,
upon request.
ided ebove meats the City's public contracting requirements, end the documentetion can be provided
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Finance Director
1.51.:10 ~
Date
Employee Signature:
Funds appropriated for current fiscal year: '~I NO
Comments: JJo (I ~ ~ /&>o" ro tI.-.T
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G: FinanoeIProcedurelAP\Forms\FOIm #3. Requisitlon.doc
Updated on: 7/2912010