HomeMy WebLinkAbout2011-078 Contract - Thomas MurphyS
Contract for PERSONAL SERVICES less than $25,000
G 1 T Y o F CONSULTANT: Thomas V. Murphy, LLC
�SH LAN D CONTACT: Tom Murphy, 541-482-3951
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 755 Capella Circle, Ashland, OR 97520
Telephone: 541 /488-6002
Fax: 541/488-5311 TELEPHONE: (541) 482-3951
DATE AGREEMENT PREPARED: 5/19/2011 FAX: t3murphy@charter.net
BEGINNING DATE: 5/20/2011 COMPLETION DATE: 6/30/2
COMPENSATION: $50 per hour up to a maximum of $20,000.
SERVICES TO BE PROVIDED: Tom will serve as a forestrv bum consultant for I
burning work on City of Ashland forestlands and as part of the City's role in the Ashland Forest Resiliency Project on U.S.
Forest Service public land. Tom will help design burn plans, coordinate contracting, assess prescribed bum implementation
and safety, evaluate buming operations, and help assess post bum effectiveness and ecological effects. Tom may submit
oral and written documents to the City during the course of work. Work will be a combination of field and o�ce.
ADDITIONAL TERMS: Consultant is a sole proprietor with no employees under this contract.
Pursuant to AMC 2.52.040E and AMC 2.52.060, after reasonable inquiry and evaivation, 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 departmenYs 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 consultanYs 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 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
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. 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 Consuitant 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 of this contract is $18,703 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
pertorming 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 (inciuding 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, ConsultanYs employees, agents, and others designated by Consultant to perform work or services
Contrad for Personal Services, Revised 0728/2010, Page 1 of 5
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 �tldays' notice in writing
and delivered by certified mail or in person. !v�
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Consuitant, 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 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 reguiation to be heid 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 ConsultanYs 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. Obliqation/LiabiliN 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 pertormance 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 Ciry. Any attempted assignment or subcontract without written consent of City shall be
void. Consultant shall be fully responsibie 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 QRF status pursuant to the QRF
Rules or loses any license, certificate or certification that is required to pertorm the Services or to qualify as a QRF if
consultant 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.
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 insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000 1 000 00 $2,000,000 or Not Applicable for each claim, incident or occurrence. This is to
cover damages caus omission or negligent acts related to the professional services to be provided
under this contract.
c. General Lia 'nsvi� ce with a combined single limit, or the equivaient, of not Iess than Enter one:
$200,000, $500,00 1 000 000, $�,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall inc ntra�tfial 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:
Contract for Personal Services, Revised 07/28/2010, Page 2 of 5
15.
16.
17
$200,00 $50{� 00,000,7$1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
includin� co�era�for owned, hired or non-owned vehicles, as applicable.
e. Notice of cancellation or chanqe. There shall be no cancellation, material change, reduction of limits or
iFltent not to renew the insurance coverage(s) without 30 days' written notice from the Consuitant or its insurer(s) to
the City.
f. Additional Insured/Certificates of Insurance. Consultant shall name The City of Ashland, Oregon, and its
elected officials, o�cers and employees as Additional Insureds on any insurance policies required herein but only
with respect to ConsultanPs services to be provided under this Contract. The consultanYs 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. 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.
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.
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.
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.
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 ailow
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.
ey �Gh~�,f
Signature
v. �����Y
Print Name
�owHs V• 1 h�.,p�+v, �CL
Title
W-9 One copy of a W-9 is to be submitted with
the signed contract.
City of Ashland
By
Department Head
�UKN ✓JI'P�.JS
Print Name
S -ao-ao�i
Date
Purchase Order No. 7
Contract for Personal Services, Revised 0728/2010, Page 3 of 5
5
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.
0 1�
Contractor
(Date)
Contract for Personal Services, Revised 07/28/2010, Page 4 of 5
OP ID: KMI,
A `°R O° CERTIFICATE OF LIABILITY INSURANCE DATOrJIZOI'I���)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S�, AUTHORIZED
REPRESENTATIVE OR PRODUCER N`1D THE CERTIFICATE HOLDER.
IMPOR7ANT: If the certificate holder is an A�DITIONAL INSURED, the policy(ies) must be endorsed. It SUBROGATION IS WANED, subject to
the tertns antl condftions ot the policy, certain policies may require an entlorsemeM. A statement on this certificate dces not conter rights to the
certificate holtler in lieu of such endorsement s.
PRODUCEii 541-773-5358 °O Karoline� ou
Protectors Insurance, LLC pHONE ��_773_�� ac N,: $q1
Pilol Rock Ins Agency LLC (CA)
vo Box 4669 E�'^'� karoli rotectorsins.com
A R 55'
Mediord, OR 97607 PRODUCFR MURPH-2
Karol M.Igou
INSUR S AFFOROINOCAVERAOE NAICtl
INSURm ThomasVMurphyLLC INSUREHA:KIf153ICIfI5Uf3fIC2COR1 an
755 Capella Cir wsuneR e Cas Ins Co ofAmerica
Ashland, OR 97520 iNSUaERC:Darwin Select Insurance Co
INSURER D:
INSURER E:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY RE�UIREMENT, TERM OR CANDITION OF ANY CONTRACT OR OTHER DOCUMEM WITH RESPECT TO WHICH THIS
CERTIFICA7E MAV BE ISSUED OR MAY PER7AIN, 7HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC7 70 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWMS.
INSR TYPEOFINSl1RANCE A��LSUB OLIC NUMBE ��ICYEFF POLICYEXP �IMITS
QENERALIIABILITV EACHOCCIIRRENCE S 'I�OOO�OO
A X GOMMERCIRLGENERALLIABILITV x 0����OZ204�-� 0$/19/�� �$��9/�Z pREMISES aaccurrence 5 100
GLAIMS-MADE a OCCUR MED EXP (Anyana parsan) 5 E%CIUd2
PERSONALBAOVINJURV E ��OOO�OO
GENERALAGGREGAtE ��OOO�OO
GEN'LAGGREGATELIMRAPPUESPER: PRODUCTS-COMP/OPAGG 8 EXCIUAO
POLICV PRO�
AUTOMOBILELIABILITY X CAMBINEDSINGLELIMIT S ��OOO�OO
B X ANVAlfrO BA-1A885181 05/19/17 05/79/1S �aaccieanp
BOOILV INJURV (Per parson) 5
ALLOWNEDAUTOS BODILVINJURV(PeraccidenU 5
SCHEDULED A1R05 PROPERTV OAMAGE
X HIREOAUTOS (Peraccitlent) S
X NON-0WNEDAUT0.S 5
3
UMBRELLALIAB p��q EqGMOCCURRENCE 5
EXCESSLIAB ��AIMS-MAOE AGGREGFTE 5
DEDUGTIBLE 5
REfEMI N 5
WORNEflSCOMPENSFTION W��TAT� �TM'
ANDEMPLOYERS'LIABILITY YIN
PNV PROPRIEfORIPARTNER/FXECUiNE El. EAGH ACCIDENT 5
OFFICEHIMEIABERE%CLUDEDi N�A
(ManEatorylnNH) E.L.qSEASE-FAEMPLOVE 5
Ifyes tlescnbeurber
DESCRIPIIONOFOPERATIONSbNaw E.L.qSEASE-POLICVLIMR 5
C. ProfessionalLiab W06�785 05A8177 05N9N2 PerClalm 1,000,
Aggregate 1,000,
OESCRIPTION OF OPEflATIONS I LOCATIONS VEHICLES �ACac� RCORD 101, lbtlltlonal Remarks Se�etlule, ii more space is requlretl)
onsultlng Forester
City of Ashland
20 E Main Str
Ashland, OR 97620
CITYAS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WIiH THE POLICV PROVISIONS.
AUTHORIZEOREPRESENTATIVE
Karol M. Igou
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD�
Thomas V. Murphy
755 Capella Circle
Ashland, OR 97520
541-482-3951 (I�
541-944-6622(C)
t3 murphv(�a,charter.net
Proposal for Burn Consultant Contract
Specialized Experience: I have 30 yeazs experience with prescribed burning as an
employee working for the BLM and US Forest Service in Southwestem Oregon. I have
been a federally qualified Prescribed Fire Bum Boss since 1984. I have created bum
plans for over 600 burn units includ'mg underburn and handpile burning. As the BLM
Fire Management Officer from 11/1999 till retirement in 8/2010, it was my duty to
review and approve all of the Districts written burn plans, assessing the adequacy of the
safety, smoke impacts, stailing levels, fire behavior predictions, and prescription
attaiiuuent elements for each bum plan.
BLM has been heavily dependent on conh�acting for prescribed buming and I have 28
yeazs experience in the administration of prescribed buming and fuel hazard reducrion
conh�acts, creation of contract specifications, and monitoring conh�actor performance.
Capacity and Canabilitv to Perform the Work: The Prescribed Burn Consultant duties
required by the city aze the equivalent duries that I have performed during my 30 yeaz
cazeer. I have remained current in my qualifications and am capable of executing the
duries expected of this position.
Educational and Professional Record: Received my Bachelor of Science degree in
Natural Resource Management from Rutgers University in New Jersey in 1978.
Completed continued education in rivo programs: Technical Fire Management thru
Colorado State, 1989; and the Natural Resource Institute thnz Oregon State, University of
Washington and Washington State in 2004.
My contract experience has been on the administration of contracts side and not as a
contractor. However, tlus has included monitoring and evaluating project costs, work
quality, and contractor's ability to meet schedules. In 2004, I received the BLM's
"Excellence in Ecosystem Management Individual Awazd" for the success of fuels
management program in the Medford District and for the development and
implementation of the BLM's first Indefuvte Delivery-Indefuute Quantity (IDIQ)
contracts for fuels management that became the model for entire Bureau.
Availabilitv to Perform and Familiaritv with the Area: I am cutrently working part-time
for the BLM developing the fire management portion of the Soda Mountain Wildemess
Area. This work takes 2 to 3 days a week, is flexible, and is scheduled to be completed in
late April. I will be teaching fire management courses at Rogue Community College, but
only for a total of 5 days, and Uus too ends in late April. My 30 years living in Ashland
and conducting prescribed burning in Southwestern Oregon have allowed me to become
fanuliar with the vegetation, weather patterns, potential micro-site fire behavior
influences, and the ignition and holding resource needs for implementing prescribed fire
in the Ashland azea.
Cost of Services: I propose $50 per hour or equalivant.
Thauk you for your consideration of ine for these duties.
Sincerely
Tom Murphy
Page 1 1
C 1 T Y O F `,fI�I
�S H LAN D DATE"�:;'`��; 6 NUMBER'_-`��
20 E MAIN ST. 5/31/2011 10193
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 006917 SHIP TO: AShland Fife Department
MURPHY, THOMAS (541) 482-2770.
755 CAPELLA CR. 455 SISKIYOU BLVD
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point:
Terms: N@t
Req. Del. Date:
Special Inst:
Forestry burn consultant for forestry
burning work on City of Ashland
forestlands and as part of the City's
role in the Ashland Forest Resiliency
Project on US Forest Service public
land.
Compensation: $50.00/Hour, Not to
exceed $20,000
Contract for Personal Services
Beginning date: 05/20/2011
Completion date: 06/30/2012
Insurance required/On file
FY 2011 $8,000
FY 2012 $12,000
si��'ro: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND. OR 97520
II�
��/i
e
Req. No.:
Dept.:
contact: Chris Chambers
Confirming7 NO
i�'
SUBTOTAL
rax
FREIGHT
TOTAL
VENDORCOPY
FORM#3 c�TV OF
A request for�a Purchase Order �SH LAN D
REQUISITION Dateofrequest: 05/24/2011
Required date for delivery: 05/25/2011
Vendor Name Thomas V. Murphy, LLC
A City, State, Zip 755 Capella Circle, Ashland, OR 9 752 0
Contact Name Telephone Number Tom Murphy, 541-082-3951
Fax Number
Description of SERVICES
Tom will serve as a forestry burn consultant for the City of Ashland for foresVy buming work on
City of Ashland forestlands and as part of the City's role in the Ashland Forest Resiliency Project
on U.S. Forest Service public land. Tom will help design burn plans, coordinate contracfing, assess
prescribed burn implementation and safety, evaluate burning operations, and help assess post
burn effectiveness and ecological effects. Tom may submit oral and written documents to the City
during the course of work. Work will be a combination of field and office.
Item Quantity Unit Destription of MATERIALS
Per attached QUOTE
$'8,000•
Unit Price
ProjectNumber______•___ AccountNumber670.08.29.00.604160 AccountNumber___-__•_
AccountNumber___•__-_ AccountNumber___•__-_
'Expenditure must be charged to the appropriate account num6ers forthe financials fo reflect fhe actual expenddures accurately. Attach e#ra pages ifneeded.
By signing this requisifion form, l certify thaf the informafion provided above meets the City's public contracting requirements, and the documentation can be provided
upon request.
Employee Signatur Department Head Signature:
Additional signatures (if applicable):
Funds appropriated for cunent �scal year. YES NO �"o'
Finance Directo
Total Cost
Comments: $8000 to be spent in current (scal year and balance olcontracted amount in 2011-2012.
G: Finance�ProcedureWPlFormslFOrm #3 Requisition Murphy Updated on: 5242011