HomeMy WebLinkAbout2011-033 Contract - Bertocchi Builders
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Contract for GOODS AND SERVICES Less than $25,000
CITY OF
ASHLAND
20 East Main Street
Ashland. Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONTRACTOR: Bertocchi Builders Inc.
CONTACT: Mark Bertocchi
ADDRESS: 1860 Gabriel Way. Medford. OR 97501
TELEPHONE: 541-944-7137
DATE AGREEMENT PREPARED: 02/17/2011
BEGINNING DATE: Februa 14.2011
COMPENSATION: $3.791.00
GOODS AND SERVICES TO BE PROVIDED: Concrete work/install two new sidewalks 4x25 and 6x15
$1.540.00, Provide and install cover roof structure. approx. 10x10 $1.481.00. Frame in and install 3.0 door.
drywall. tape and mud $495.00. Frame in new service window. drywall. tape and mud $275.00. Frame and
install new 6.0x3.0 exterior window d all. ta e and mud $405.00
ADDITIONAL TERMS: Workers' Compensation insurance is bE}' ,
erformin all the work himself - no em 10 ees. Contractor: /'
NOW THEREFORE. pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall. provide all goods as specified above and shall at its own risk and
expense. perform any work described above and. unless otherwise specified. furnish ail 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 fuily 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 shail provide ail 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 shail 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 shail 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 wiil be seen by ail employees.
8. Indemnification: Contractor agrees to defend. indemnify and save City. its officers. employees and agents harmless
from any and ail losses. claims. actions. costs. expenses. judgments. subrogations. or other damages resulting from
injury to any person (including injury resulting in death). or damage (including loss or destruction) to property. of
whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited
to. Contractor's employees. agents. and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses. expenses. claims. subrogations. actions. costs.
judgments. or other damages. directly. solely. and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. 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 Contractor. or at such later date as ma be established b Cit under an of the followin
FAX: 541-770-3671
COMPLETION DATE: A ri114. 2011
ived because contractor will be
Contract for Goods and Services Less than $25.000. Revised12/2012010. Page 1 of 5
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 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 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 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. cor 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 QRF status pursuant to
the QRF Rules or loses any license. certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in.
or delegate duties under. the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Comoensation insurance in compliance with ORS 656.017. which requires subject employers to
provide Oregon 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:
$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.
c. 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.
includina coveraae for owned. hired or non-owned vehicles. as aDolicable.
Contract for Goods and Services Less than $25.000. Revised 12/20/2010. Page 2 of 5
d. Notice of cancellation or chanae. 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 Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates of Insurance. Contractor 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 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 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 Slate 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 Elev~nth 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 BE1WEEN 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 Councilor 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.
co~r:
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D/(' -c~cvj(
Print Name
IJAd,' .t&j4/ O-//1~
Title
City of Ashland
By ~ Q..,vl
Department Head
'\'<\. \.c.,^- ~ I t< y- 'AI. -\ I\.
Print Name
~JI() \I
Date
W-9 One copy of a W-9 is to be submitted with
the signed contract.
Purchase Order No.
/tJtJ7r
-
Contract for Goods and Services Less than $25.000. Revised 12/20/2010. Page 3 of 5
EXHIBIT A
CERTIFICATIONSIREPRESENTATIONS: Contractor. under penalty of perjury, certifies that (a) the
number shown on the attached.W-9 form is its correct taxpayer ID (or is waiting 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:
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(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.
L~dc/il t&~
Contractor
f;(2 -20/1
(Date)
Contract for Goods and Services Less than $25.000. Revised 12/2012010. Page 4 of 5
Jan 23 11 01:53p
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Mark Bertocchi
541-770-3671
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Give me a call jfyOU have anvouestions: 541-944-7137 fax #541-770-3671
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Thank You,
jJ2/;j?pi
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Mark Bertocchi
General CoI,ba..h.. - an structure
MedfoRl, Oregon
. Ja~ 23 11 01:54p
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Mark Bert.occhi
541-770-3671
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PROPOSAL
BBI
Building with Quality and Integrity
Mark Bertocchi.o......
541.944.7137
CCB#181329
Ucensed " Bonded
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PROPOSAL...... laJ TO:
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Tl1ls proposal Is subject to -.A>u- _ WA CllI}IS and tt Is -d1ere8(lor at Ihe oplion Of tho UIlIleqIgnod
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ACCEYI'ANCE OF PROPOSAL
The ebove prlcea. spoclllcotlons and ccndIlIDns lUll hereby accepIed. you.... 8UIhO_1o do II1e wort as sp8dftod. Payment wiD
lie made as oulIlned above.
Acc:epleG:
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Date:
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Jan 23 11 01:54p
". . ,
Mark Bertocchi
541-770-3671
BERTOCOIlBUILDERS INC.1/23/21111
Project: City of Ashland Public Entrance off Mountain Street.
Addendum Dated 1/23/2011
1. Option 1. Conaete work, Install two new walk ways. One 4x25 and one6x15.
2. Option 2. Provide and install cover roof structure approx 10x10.
3. Option 3. Frame in and install 3.0 Door. drywall, tape and mud.
4. Option 4. Frame in new service window. drywall, tape and mud.
S. Option 5. Frame and Install new 6.00.0 exterior window drywall, tape and mud.
Total for above work $4196.00
Authorization Signature
Accepted Signature
p.3
Cost 51540.00
Cost $1481.00
Cost $495.00
COSt$27S.OO
COSt$40S.00
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THISCERTIFlCATEISIB6UED AMATTEROPI PO JlDNONLY NDCONFERSNORlGHTSU S
CERTlI'ICATE DOEs NOT AFFUlIIIA TM!L Y OR NEGATII/EL Y AMEND, EXTEND DR AL TEN THE COVERAGE AFFORDED BY THE !,ouoes
BELOW. THJS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IJlSURER(lI). AUTHORIZED
REPRElIENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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the tenns and conditions of tho pDllcy, I:lnah poUclDs mar reqUIre an endDrIement. A ltatlment on CNs clrtlncalo dol.. nol confer rlgNs 10 the
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PMDUCER
CERTIFICATE OF LIABiliTY INSURANCE
OP ID Ial
Hart J:Dsurance
112 3 l\oya~ Ave,
Nadtoxd OR 97504
PhoDs:S41-119-4232 rax:54~-772-3963
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COVERAGES
CERTlFlCA TE NUMBER:
REVISION NUMBER:
THI~~IFYT""'IH."u"CI.'U" Ltsl~LlDt.LuwHAVE 8
INDICATED. NO'lWfTHsYAIIlDING IWY REQUIREMENT, TERM OR CONDITION OF /1N'f CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ~IC:I-f THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IHSURANCeAFPOR.D!D BVYHe POllC(ESDESCRI8EDKEREIN IS SUBJECT TO ALL THE TERMS,
EXCI.USlONS AND CDNQITlONS OF SUCH POLiCljiiMITS &HOWN ,""YHAIIE BEEN REDUCED BY P.._
ioTA T'IPIiOfI'fSURANCIi INSR PDLlCYN\1M8iR ~ LIM/T"S
~101A,Q1L1!V _ """",<lCCUlllENCl! 1 1,000 ,000
A ~ ~r,.IrlOENERH..Ll.t8lLlTV BUD001:l.008 OJ/12111 03112112 PRl!M16E8(ElocctJTIlI09) .100 000
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CERTIFICATE HOLDER
CANCElLATION
CZ'nASH IHOULDANY OF THIi ABove DIiSCIl8CU POLICtiB Be CANceLLED BEFORE
Tie DPUIATIOI\I DATI! THERI!()I!, NOTleE WlU. BE De~ N
ACCORDANCE WJTH Tim POLICY PROVllJONl.
Ci t:y of Ash~a..cl -
attD: Dale Piot". AUTHOftIZIiD fUiPftE'SENTAl1VE
20 11:. Main Street Hut Iil8...,iUlCe / Medfoxcl
A;h~aDcl OR 91520
ACORD 25 (2008108)
01888-2008 ACORD CORPORATION. A1lrlghl. reoerved.
The ACORD name and Iago are regls1enld mOtlUl of ACORD
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/'A"' STATE FARM INSURANCE COMPANIES@
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PO-Sox 5000
Dupont WA 98327-5000
DATE OF NOTICE: MAR 08 2011
CODE:
4fA
ATl
15
A
000291
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1850
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT COnNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
8
7
6
5
4
3
2
Slate Farm Mutual Automobile Insurance Company
NAMED INSURED: POLICY NO: 0026612.F22-37M
BERTOCCHI. MARK YR/MAKE/MODEL: 2005 CHEVROLET PICKUP
DBA BERTOCCHI BUILDERS VIN/CAMPER: 1 GCHK23235F847007
1860 GABRIEL WAY AGENT NAME: JON SNOWDEN
MEDFORD OR 97501-4154 AGENT PHONE: (541)482.2461
ENDORSEMENT NO: 6028BJ
POLICY MESSAGES: This polley shown sbove supersedes policyl 0026612-37L.
The policy includes a 1088 payable clause protecting the additional inaured's interest in the described car to the extent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice if the po.licy ia terminated. Untilauch notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify ue within 10 days of
any change of interest or o~nerahip coming to their attention. Failure to do 80 will render this policy null and void.
9A 13.F473-H
COVERAGE:
81 AND PO LIABILITY
$1 00,0001$300,0001$50,000
$250 DED. COMP.
$1000 DED. COLL
POLICY EFFECTIVE
FEB 22 2011 UNTIL TERMINATED
.
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..11
CITY RECORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND. OR 97520
(541) 488-5300
Page 1/1
I....,,;;::DATE' '.' " "1
3/14/2011
1':- P01NO~~~ER"1
VENDOR: 013674
BERTOCCHI BUILDERS INC
1860 GABRIEL WAY
MEDFORD. OR 97501
SHIP TO: Ashland Building Maintenance
(541) 488-5358
90 N MOUNTAIN AVENUE
ASHLAND. OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.:
Contact: Dale Peters
Confinning? Yes
!~?'Quaniitv,\.,~ '~ :UniC::' '-.: '.". <:c>:'" .., ... _....to.-. ." 'lbescrintiorl'" . (-. ':'1, . '...:' . .,Un"lt Price":'.'~~; ~:::~:'~ Ext:.p.rice'~,:~::-:
. ..~. ' .- .',...'
~.. '.. -
Service Entrance @ 90 N. Mountain 3.791.00
Concrete work/Sidewalks $1.540.00
Roof Structure/Awning $1.481.00
Frame, Install & Finish 3.0 Door $495.00
Frame. Install & Finish Service Window
$275.00
,
SUBTOTAL 3 791.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 3.791.00
ASHLAND, OR 97520
1':~;.:"AccounfNi..llnOe'r, ~~ :;:}:' ~;.~~f;;p:iojec(Nlllnber .: .. . Am',iunt: . : "Accou'rit:Number,r<:i ;~2.."'1 proje"ct;Numoer:::' ,J,:_ ;-'~:;'~:~~AmoLiiit.~ ,:;;.\~j
"' ,
E 410.08.24.00.70420 E 000228.999 3 791.00 .
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Authoriifrt:! 51 nature VENDOR COPY
9
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
Date of Request:
16 FEB 2011
THIS REQUEST IS A:
DChange Order(existing PO #
Required Date of Delivery/Service:
ASAP
Vendor Name
Address
City, State. Zip
Telephone Number
Fax Number
Contact Name
BFRT()(Y':1-l1 RI III m::R~ INr.
MArlfnrn OR Q7li01
541.944.7137
I"g,b?' 6elG.r/~ CU<k-;-
MARK BERTOCCHI
SOLICITATION PROCESS
Small Procurement
Less than $5,000
Quotes (Optional)
D Sole Source
D Wrillen findings allached
D Quote or Pro osal allached
CooDerative Procurement
D State of ORlWA contract
D Other govemment agency contract
D Copy of contract allached
D Contract #
D Invitation to Bid
(Copies on file)
D Reauestlor Prooosal
(Copies on file)
D Soeciall Exemot
D Wrillen findings allached
D Quote or Pro osal allached
D Emeraencv
D Wrillen findings allached
D Quote or Pro 0581 allached
Intermediate Procurement
D (3) Written Quotes
(Copies attached)
Description of SERVICES
Cc,""c.......-b'" 00R.l<-S'l>",,,",,"'LKb I~O.oO
l'\=+- 51o.R.'-'<>-.........", #\,"","".~':'l I 't81.cCJ
rr2.Io"'\fY""le.,T~'T'..qu...- F,,,,,,~\" 31C \)c::oe.. '-i9S,ca
f"Z";2....q,rne:.. ~11oC\L.L.-o- F''''''l.sh. SeQ.\J~E ~'f\:l~ 27s.ca
Per attached PROPOSAL
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
D Per attached QUOTE -.;3"'-7 dCl.:i'...:-- :;z. - / '-1- I I
Project NumbeU00228.999 (!.p7-""'ru~;t'X..-dd<<,: ~-/t/ -I f
Account Number 410.08.24.00.704200 ~ ~
. /tems and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition form, / certify that the information provided above meets the City of Ashland public contracting requirements,
and the documentation can be provided upon request.
Employee Signature: '--- ~~ ~ SupervisorlDept. Head Signature: . '\\r\.u\a...<Q \l.~
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 2/1612011