HomeMy WebLinkAbout2010-141 Contract - Law Offices Lloyd Haines
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Contract for PERSONAL SERVICES Less than $25,000
CITY OF
ASHLAND
20 East Main Street
. Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONSULTANT: Lloyd Hains, Attorney at LavJ
CONTACT: Lloyd Haines
ADDRESS: 96 North Main Street, Ashland. OR 97520
TELEPHONE: 541-535-6822
DATE AGREEMENT PREPARED: 07/29/10 FAX: None
BEGINNING DATE: 08/01/10 COMPLETION DATE: 6/30/11
COMPENSATION: $35 er hour
SERVICES TO BE PROVIDED: Repair the tree sculpture known as We Are Here based on the list provided by
the consultant in June 2010. Provide one inspection during the Spring of 2011 of the sculpture. Consultant,
will contact the City of Ashland two weeks in advance to coordinate repair work, inspection and needed
e ui ment and submit a written re ort when the re airs have been com leted. See attached addendum.
ADDITIONAL TERMS: Repair work will not exceed 45 hours. Inspection work will not exceed 5 hours and will
submit a written re ortdetailin the re uired re air work and estimate of the time re uired to conduct the work.
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 oi the mutual covenants contained herein the CITY AND CONSULTANT AGREE as
follows:
1. Findings / 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, furnish all labor, equipment and materials required for the proper performance
of such service.
3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel
assi9ned 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. 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. .$1 t.'140
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 of this contract is ~4 8,e~ 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 aiso 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, soiely, and proximately caused by the negligence of City.
10. Termination:
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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
written 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. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no ionger 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 O( 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 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 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. Oblioation/Liabilitv 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, Consultant shall immediately cease all activities under
this contract, unless expressly directed otherwise 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 Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. Professional Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1.000,000, $2,000,000 or Not Applicable for each 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. General Liabilitv insurance with a combined single limit, or the equivalent, of not less than.Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
d. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000.000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
e. Notice of cancellation or chanoe. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coveraoe's) without 30 davs' written notice from the Consultant or its insurer's) to
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, . the City.
. f. 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. The consultant's insurance is primary and
non-contributory. 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. tf
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,
MODIFtCATION 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.
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 ap'propriations, limitations or other expenditure authority, City may terminate this
contract without penalty.or liability t6 City, effective upon the delivery of written notice to Consultant. with no further
liability to Consultant.
Certification. Consultant s
CONSULTANT.
u.
tion attached hereto as Exhibit A and herein incor orated b reference.
CITY OF ASHLAND:
BY
_ n~JAW~[ QIRI!CT9R
4~ bf'c..e....,?? ,
TITLE
DATE
W-9
One copy of a W-9 is to be submitted
with the signed contract and it will be
kept on file in the Finance Department.
ACCOUNT #
~/'~t7g ~~G&~cflt
(For City purposes only)
PURCHASE ORDER #
ttJ~'7~7
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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 IicensE;ld 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:
~) I carry out the labor'or services at a location separate from my residence or is in a
}-pecific portion of my residence, set aside as the location of the business.
V (2) Commercial advertising or business cards or a trade association membership are
purchased for the business. .
-f'(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.
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(ate( .
Contractor
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C I T Y 0 F ASH LAN D, 0 REG 0 N
Lh\b\ r ~.
City of Ashland
LIVING
WAGE
ALL employers described
below must comply with City
of Ashland laws regulating
payment of a living wage.
~~,
Employees must be paid a
living wage:
""r:DED perho~r;eff~
;~\\::','~i':_'._'~'_'_'_-.",. _ ''_'',_'
- ;;~,:;___r----:,:,>-~~ f'J' ;< - -'.\ ,;: '. ,":i
1;he I;;.iving Wage is.a
", ~-;!_{7:t+>"-~d_'-~<;'\:::" ',' t"<F<;
:. ;tJune'30:by the Co
-~!:;';~~'4::0:<_~1:nJ;>-' _~ :},',{ ':'; :;. ,<,:~: +:.-'.:,{ :";
-- '. -...
i~~~!une 30,~010.,
..,,:,;.
"'::'. "':,:::;.',: ;::.f~sJ:I~h]-;:-:f
nually e.~e
':':'::',.::.".. .1_:,<
ice Indi!~
,",
~ For all hours worked under a
service contract between their
employer and the City of
Ashland if the contract
exceeds $18,703 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
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 $18,703.
~ 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 eiigible
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 ~mployees.
CITY OF
ASHLAND
'.'
07/29/2010
Contract addendum
Lloyd Haines
"We Are Here" (tree sculpture)
CITY OF
ASHLAND
As owner of the "We Are Her~" tree sculpture, the City of Ashland recognizes the piece has significant importance to
the Native American Community in southern Oregon. The City will pay for the repairs identified by artist Russell
Beebe in June of 20 10.
Because the sculpture is made of wood and is exposed to the elements it is likely the piece will deteriorate much more
quickly than other pieces in the City's public art collection. In the future, it may not be possible to accommodate
repairs and maintenance of the piece that meet the expectations of the artist and the Native American Community.
The City will evaluate the sculpture from year to year and determine whether to leave the piece in its current location,
allow it to age naturally and provide funds for basic maintenance, or if necessary, at some future date, to retire/relocate
the sculpture to protect and preserve the piece.
Scope of Work
Reoair:
Consultant will repair the sculpture based the repairs identified during the inspection in June of201O (attached).
The Consultant must contact the City of Ashland at least two weeks in advance prior to doing the repairs.
Soring Insoection
The purpose of the Spring 20] 1 inspection is to assess necessary cleaning, refinishing, damage repair and/or restoration
requirements. Following the inspection, consultant will submit a written report to the City summarizing the results of
the inspection. The City will determine whether or not to authorize those repairs.
Cleaning
City personnel will clean the sculpture once per year consistent with the suggested instructions submitted by Russell
Beebe on behalf of consultant.
Fee Structure
Inspection and repair work done within the framework of this agreement will be billed on an hourly basis, at a rate of
$35 per hour. Inspection and repairs will not to exceed 50 hours (maximum five hours for Spring 20]] inspection and
45 hours for repairs).
This contract serves as authorization by the City for the list of attached repairs to be conducted by the consultant. No
compensation will be paid for additional work. The numbcr of hours billed for repairs will be based on the estimates
provided by the artist in June 2010 (attached). lt is understood that the Consultant will not continue working if the
actual time exceeds the estimated time.
Billing
Invoices will be sent monthly and will be due 30 days from the invoice date. Past due amounts will be assessed a 1.5%
penalty.
Contract Term
Either party has the right to terminate the contract at any time by giving a minimum of 60 days written notice in
advance of the contract ending date.
ADMINISTRATION
20 East Main Street
Ashland, Oregon 97520
WNW.ashland.oLus
Tel: 541-488.0002
Fax: 541-488.5311
TTY: 800.735.2900
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ThiS certifies that,
Certificate of Insurance
~ State Farm f:ire and Casualty Company. Bloomington, 1lI1nois
State Farm ~eneral Insurance Company, BtoDmington. Illinois
State Farm Fire and Casualty Company, Aurora, Ontario
State Farm Florida Insurance Company I Winter Haven, Florida
State Farm L1oyds, Dallas. Texas
A
IN.uIUlCl
.
insures the following policyholder for the coverages indicated below:
Policyholder HAINES, LLOYD MATTHEW DBA LLOYD MATTHEW HAINES ATTORNEY AT LAW
Address of pOlicyholder 96 N MAIN ST STE 202 ASHLAND, OR 97520-2792
Location of operations 96 N MAIN ST STE 202 ASHLAND, OR 97520-2792
Descrip~on of operations ATTORNEY OFFICE
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of fiability shown may have been reduced by any paid claims.
Policy Period Limits of Liability
Policy Number Tvpe of Insurance Effective Dale i Expiration Date (at beginning of policv period)
Comprehensive i BODILY INJURY AND
97 -BZ-4944-6 Business Liabil~y MAR-29-10 APR-02-11 PROPERTY DAMAGE
________n____._______~________ ~----~--d.---------~------~-~ ~___.__u___n~_________.l._~__~nh~h_n___._._u__
This insurance includes: IX Products - Completed Operations
Contractual Liability Each Occurrence $ 1,000,000.00
i?5 Personal Injury General Ag9regate 2,000,000.00
i?5 Advertising Injury $
X GENERAL LIABILITY Product - Completed
- $ 2,000,000.00
Operations Aggregate
Policy Period BODILY INJURY AND PROPERTY DAMAGE
Policy Number EXCESS LIABILITY Effective Dale i Expiration Dale (Combined Sinqle Limit)
o Umbrella Each Occurrence $
o Other , Aoor>>oate $
,
Policy Period Workers Comcensation - StatutorY
Effective Date : EXDlration Dale Part 1-
Workers' Compensation Part /I - Employers Liability
and Employers Liability Each Accident $
, Disease - Each Employee $
,
Disease ~ Policy Lim~ $
Policy Period Limits of Liability
Policy Number Type of Insurance Effectlve Date i Expiration Date (at beqlnnlM of policv period)
,
,
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described polities are canceled before
their expiration date, State Farmfll will try to mail a
written no~ce to the certificate holder 30 days
before cancellation. If we fail to mail such notice, no
obtigation or liability will be imposed on Stale Farm or
its agents or representatives.
~V\9A ( -i
Signature of Autho~ed e es ntatlve
INSURANCE ACCO NT REP 03/30/10
Title Date
JON SNOWDEN, STATE FARM AGENT
Agent Name
Telephone Number (541) 482-2461
Name and Address of Certification Holder
THE CITY OF ASHLAND, OREGON
AND ITS ELECTED OFFICIALS
OFFICERS AND EMPLOYEES, AS
THEIR INTERESTS PERTAIN TO THE
"HERE WE ARE" TREE SCULPTURE
AND "THE PATH TO JOY AND UNITY" MURALS
20 E MAIN ST
ASHLAND OR 97520-1814
I Agent's eode Stamp
Agent Codt>
AFO Code
1001260
106JS9.10 00-25-2009
CITY RECORDER
Page 1/1
~~,
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
i:[';; :"_'~i~t;'DA TEA~',:r:;-:;';}l :;iJ:j(R();l,nJMBER~i'~~l
8/18/2010 09757
VENDOR: 003826
LAW OFFICES LLOYD M HAINES
96 N MAIN STREET
SUITE 202
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
SHIP TO: City of Ashland
(541) 488-6002
20 E MAIN STREET
ASHLAND, OR 97520
Req. No.:
Dept.:
Contact: Ann Seltzer
Confirming? No
~uanlj~D rrun~ Il~~IB~~!~JL~'f!J~[;i~~1EI'BEG~~~roescriPifO"n'tmrr.)~~~':~l:~~~~r.::t;'~i,:"r: tl'?~;.~F:.;d}))')~:fff~~HJnfijfric~~(;~ t~:;t~Ext?;;F~frlcaiW
Repairs to "We Are Here" tree sculpture 1,750.00
by artist Russell Beebe. Not to exceed
50 hours @ $35.00 per hour
.Contract for Personal Services
Beginning date: 08/01/2010
Completion date: 06/30/2011
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
1 750.00
0.00
0.00
1,750.00
,-Accounl1Numtiet IIIIIIP.rojOci~~ _A'"n'i~. ~;rAccQUnmwm~~r~ ~:~_Rroiect'JjUinb~~ ~
E 410.08.24.00.60240 1 750.00
?/;?//o
~ .;:1. A~ Si9nature
VENDOR COPY
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND,
Date of Request:
I'T-_.....................I
..WJI/J11';' ,
,.".., i' ,.,.'.,..'.....""'--
THIS REQUEST IS A:
o Change Order{existing PO #
Required Date of Delivery/Service:
9t/on~/H,/k;k:t) ,~;; at ~
itJ.J,.l~JA... rP~.. q'7~):U , '
/)'1 1-.-'>. l-S-- {d~
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement
D Less than $5,000
D Quotes (Optional)
Source
ritten findings attached
Quote or Pro osal attached
CooDerative Procurement
D State of ORfWA contract
D Other government agency contract
,
D Copy of contract attached
D Contract #
D Invitation to Bid
(Copies on file)
Intermediate Procurement
D (3) Written Quotes
(Copies attached)
D ReQuestfor ProDosal
(Copies on file)
D SDecial1 Exempt
D Written findings attached
D Quote or Pro osal attached
D EmerQencv
D Written findings attached
D Quote or Pro sai attached
Description of SERVICES
I ~ ~ lWe Are. If~/e-.' 'flee.... oJtULp-ItJ1 kJ a/M
~ J$eNL not- <tb f)/.tM-rL 55 . hNd tJ&IJ
PIA.-.
o Per attached PROPOSAL
Item # Quantity
Unit.
Description of MATERIALS
Unit Price
Total Cost
o Per attached QUOTE
Project Number ____.._.___
Account Number YJa. f)Q,J.JdfJ... !J~l)li(2'j)
'Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition fonn, I cerlify that the infonnation provided above meets the City of Ashland public c
and the documentation can be provided uponJequ,est.
Employee Signature: ~ ~ ~ Supervisor/Dept. Head Signatur .
requirements,
G: Finance\Procedure\AP\Fonns\8_Requisition form revised.doc
Updated on: 8/1212010