HomeMy WebLinkAbout2011-096 Contract - Green Time Landscape
Jun,I4 2011 10:20AM
Contract for GQODS AND SERVICES Less than $25LQOO_
N Mtn Park Nature Center
No. 0247 P 2
CITY Of
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 5411488-5311
CONTRACTOR: Green Time Landscape
CONTACT: Stacy Page, President
ADDRESS: 1407 N. Hwy 99, Ashland, OR 97520
TELEPHONE: 541-488-0986
DATE AGREEME~:rPREPARED: 06/1312011 FAX: 541-488-4610
BEGINNING DAlE: Q6115/2011 _QOMPLETION DATE: 0fi/30/2011
COMPENSATION: -Not to exceed 2,486.00, per attached proposal
-GOODS AND SERVICES T6sE -PROVIDED: Contractor'to- furnish all materials arid labor necessary to
remove existing pond liner and install new EPDM liner and cover - per attached proposal dated 06/06/2011,
Job to be completed prior to June 30, 2011.
ADDITIONAL TERMS: Payment will be made in full within 14 days of satisfactory completion.
NOW THEREFORE, pursuant to AMC 2.50.090'iind after consideration ot'itie mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shal" provide all goods as specified above and shall at ils own risk and
expense, perform any work described above and, unless olherwJse 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, (hat any personnel
assigned to the work required under this contract are fully qualified to perform fhe 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 re9istered, 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.
Compem;ation 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 Ihis contract shall be the property of
Cily. .
6. Slatutory Requirements: ORS 2796,220, 2796.225, 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 wilh chapter 3,12 oflhe Ashland Municipal Code by paying a
living wage, as defined in this chapter, 10 all employees performing work under this contract and to any subcontractor
who performs ~O% or more of the work under this contract. Contractor is also required to post the notice aUached
hereto as Exhibit 6 predominantly in areas where it will be seen by all employees.
8, Indsmnlflcatlon: Contractor agrees to defend, indemnify and save Cily, 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 destrucllon) 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 (his
contract), Contractor shall not be held responsible for any losses, expenses, claims, subrogatlons, 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 tenninated at any time by mutual consent of both parties.
b, Citv's Convenience, This contract may be terminated at any lime by City upon 30 days' notice In writing
and delivered by certified mall 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 dale as may be established by City under any of the following
conditions;
Conlrsct for Goods and Services Less Ihan $26,000, Revllled 1212012010, Page 1 of 6
Jun, 14. 2011 10:21AM
N Mtn Park Nature Center
No. 0247 P 3
I. If Ciiy funding from federal, state, county or other sources is not obtained and continued-at levels
sufficient to allow for the purchase of the indicated quanlily 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 Conbactor 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
enllrely 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 thereatter 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 Cd) are not exclusive and are In
addition to any other rights and remedies provided by law or under this contract.
e. ObliaationlLiabilitv 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 nolice of termination (regardless whether such notice is
given pursuant to subseclions a, b, cor d of this section, Contractor shall immediately cease all activities under
Ihis 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 haa the contract been compleled, 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 thatlhe 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 thet 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.110 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, Contraclor shall be fully responsible for the acls 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 Ihe 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 certilication 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 ComDensatlon Insurance In compliance with ORS 656.017, which requires subjecl employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Liabilitv insurance wilh 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 Liability 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.
._.._.___<L-___ Notice of cancellation or chanae. There shall be no canCI1!!atiO!), material chan e reduction of limits or
Contract for Goods and Services Less than $25,000, Revised 1212012010, Page 2 of 5
Jun. 14. 2011 10: 21 AM
N Mtn Park Nature Center
No, 0247 P 4
intent "ai'to renew the insurance coverage(s)'without 30 days' wrillen notice irom the Contractor or its insurer(s) to
the City.
e. AddlllonallnsuredfCertificates of Insurance, Contractor shall name The City of Ashland, Oregon, and ils
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
wah respect to Contractofs 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 wUl specify all of the
parties who are Additional Insureds. Insuring companies or entilies 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 andfor 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") belween the City (andfor 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 Ihe Jurisdiction.
18, THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BElWEEN 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
HEfSHE 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 Clly's fiscal year budget. Contractor
understands and agrells that City's payment of amounts under this contract attributable to work performed aller Ihe
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of lis 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 wrillen 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 allached hereto as Exhibit A and herein incorporated by
reference.
:;ntrac~ _ (2....... ::~OfAt2~ "-.
Slg~at re ~ Department Head
S~ -. ~~ ~()~rfb___
rinl Na e ! Print Name
f/'lt2.S(d~ On/II
Tille Date
W-Q One copy of a W-9 is to be submilled with
the signed contract.
Purchase Order No. Cl?l CJ ~ 8
Contract for Goods and Services Less then $25,000, Revised 12120f2010, Page 3 of Ii
Jun.14 2011 10:22AM
N Mtn Park Nature Center
'No.0247 P 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS; Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-Q form is its correct taxpayer 10 (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 Ihe 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 contracl 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,
(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.
.3L; ?~
Contractor
&-/~Cj
(Date)
Contract for Goods and Services Less than $25,000, Revised 12120/2010, Page 4 or 5
l;fiGreen Time
~ Landscape
1407 N.Hwy99' Ashland,OR 97520
ph (541)488-0986 fax (541) 488-4610
lCtl.ktNel7211
llonded'In...,ed
PROPOSAL & CONTRACT
Date: 6-8-11
Proposal submitted to:
North Mountain Park
Ashland, OR 97520
Job Location:
GreenTime hereby proposes to furnish all materials and labor necessary for the satisfactory completion of:
Instal/landscape per specifications:
Bid to include:
$2,486,00
-Remove existing liner, dig out stream an additional 6 in., install
approximately 450 square fl. ofunderlayment.
-Installllew EPDM liner and cover with additiollallayer of underlay me nt,
-Replace existing boulders and cover liner with smooth gravel.
-Install flagstone for waterfalls and foam in place.
-Install 2 ball valves in hose to be able to control flow ofwater.
-Replace existing plants.
"Dirt will be left on site.
All material is guaranteed to be as specified and work is to be perfonned in accordance with the plans and
specifications for the above mentioned in a professional and reliable manner for the sum of:
Two Thousand Four Hundred and Eigbty Six Dollars ($2,486,OO),
with payments fo be made asfallows
payment 0[$1,000,00 upon acceptance of contract and $1,486,00 when project is completion.
An)' aJreralions or devialion from aben'e specifkalions in\'Ulving clIiCm costs
will be t:x~~utcd only by '-'TiUen ~bango order and $hall incur charges O\'l:r
nnd above che original "'limate. This 8gJftmenl is contingent upon accidents,
conditions and dels)... bc:)"Ond our control.
Respectfully submitted:
Stacy Page, President
Quotation valid for 30 days
ACCEPTANCE OF PROPOSAL
Th.e above cosI, specificRtions and conditions are salisfllclory and arc hcrcby accepted. Work is aulhorized. Payments will be made as outlined.
SignB!Ure:
Dale:
lnndsc81lC Contmclor's Board: Salem, OR 97301 503.986-6582
Beecher Carlson
6/14/2011 12:29:23 PM
PAGE
2/002
Fax Server
~.
~RD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJOOIVYYYI
6/14/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY rHE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATK>N IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certJflcate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER ~~~CT Paula Orti., ele
Beecher Car~son Xnsurance Agency LLC r~.NNEo, Exl): (541) 772-1111 1 f~. No); (aU) 172-3785
707 Mu%phy Rd ~~~~ss: paula. orti:r:@beeahercarlBOD.oom
~~~~:ID,pOO12597
Medford OR 97504 INSURER(S)AFFOROING COVERAGE NAIC,
INSURED INSURER A :Travelers Indemni ty Co of AM 5666
INSURER B :Travelers Indem.ni ty Co of CT 56B2
Greentime Landscape, me, INSURER C :SAIF 2412
1407 N Hwy 99 INSURER 0 :
INSURER E :
Ashland OR 97520 INSURER F:
COVERAGES
CERTIFICATE NUMBER'2D1D GL,Auto, Comp
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 REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~SR TYPE OF INSURANCE ~~:I~~ POUCY EFF POUCY EXP
LT. POUCY Nl.MBER MMlDDIYYYY MMfDDmVY UIITS
GENERAL UABlUTY EACH OCCURRENCE I 1,000,000
X COMMERCIAL GENERAL lIAB1UTY DAMAGE TO RENTED 3DD,DDD
PREMISES {Ea ocarnll1clIIl I
A - I--- CLAIMS-MADE ~ OCCUR X 6906079HB37TIA10 /1/2010 /1/2011 NEDEXP{~Me~so~ I 5,000
PERSONAL & AD" INJURY I l,DDD,DDO
GENERAl. AGGREGATE I 2,DDD,DDD
GEN\. AGGREGATE UMn APPUES PER: ~UCTS.COMProPAGG I 2,000,000
Xlprucvl I~ I 'LOC I
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I l,DDD,DDD
(EaaccldenQ
X ANV AUTO
BA6019M93010SEL /1/2010 /1/2011 BODILY INJURV (per pefson) I
8 AlL OWNED AUTOS
6(X)IL V INJURV (pel' accidenl) I
SCHEDULED AUTOS PROPERTV OAMAGE
HIRED AUTOS iPeracddent) I
NON.OWNED AUTOS t.ledcalpaymenls I 5,DDD
LeasefLoa'lGap I include<
UMBRELLA UAB T 1 :'C:MADE EACH OCCURRENCE I
EXCESSUAB AGGREGATE I
DEDUCTIBLE I
RETENTION I I
C WORKERS COMPENSATION we STATU- OTH-
AND EMPLOVERS. UABIUTY VIN TQRYLIMITS E.
ANY PROPRIETOR/PARTNERlEXECUTIVE D E.L EACH ACCIDENT I 500,000
OffICER/MEMBER o.CLUOEO? N/A
(Manda1orylnNH) 66312 /1/2011 /1/2012 E. L. DISEASe . EA EMPLOYEE I 500,DDD
~l&;~~t~~ 'cWOr>ERATlONS below E.L DISEASE. POlICV LIMIT I 5DD DDD
OESCRlPTlON OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD 101, Additional Rltmaoo Sc.hecIule, 11 more lpate il required)
Certi:ficate holder included aa addiUonal ineured .. reapecte sreneral liability .here required by wri'tten contract..
'l'hie :form is aubjec't 'to policy 'terma, cODdi'tions, ancl exclusions.
CERTIACATE HOLOER
CANCELLATION
SHOULD ANY OFlHE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPlRATJON DATE THEREOF I NOnCE WILL BE DEUVERED IN
Ci. ty of Ashland ACCORDANCE WITH lHE POUCY PROVISIONS.
20 East Mai.n Street
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
\ti.ks IlastroDi./PAOOR'l' j,;,i?-1tW ;::ft;!tUJfi&__
f /
ACORD 25 (2009/09)
INSD25 ~1IIJOO9)
Q 1988-2D09 ACORD CORPORATION. All rtgh15 reserved.
The ACORD name and logo are registered marks of ACORD
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license Number: 728~
license Status: C Actr'.
license Expiration Date: 8!3112011
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DBA:
Address:
1407 N HWY 99
ASHLAND,OR 97520
(541) 488.0986
JACKSON
Corporation
515.000,00
51.000.000.00
license Type:
Backftow Status:
licensed Since:
All Phases
Plus Backflow
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CITY RECORDER
Ashland Park Commission I:'
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
Page 1/1
6/20/2011
, DATE' " ""I
, PO NUMBER;," "
00048
VENDOR: 003765
GREEN TIME LANDSCAPE
1407 N HWY gg
ASHLAND, OR 97520
SHIP TO: NORTH MOUNTAIN PARK
620 N MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Terms: net
Req. Del. Date:
Speciallnst:
Req. No.:
Oept.:
Contact: Linda Chesney
Confirming? No
:l:'Qu'an~~~'; .,'.t'Unit;, ' .:' , .. bescri"ntion .. ' " , ' ' . Unit.Price . Ext. P-rice, .j'
-
Replace pond liner, rebuild water 2,486.00
feature, at North Mountain Park. Per
attached proposal.
Contract for Goods and Services
Beginning date: 06/15/2011
Completion date: 06/30/2011
Insurance required/On file
"
SUBTOTAL 2486.00
BILL TO: TAX 0.00
FREIGHT 0.00
rOTAL 2,486,00
::~:'.;Accounf j..,iumb'er." ".:"~ " ; Projec(Numher.. Amo'unt Account'Number .. " Project'Nurriber ; _1;' , ")'-?Amc!run(:' ~ i;1
't. " .. ,. '. .
E 211.12.03.04.60211 2 486.00
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Authoriled Si natufe z.d // VENDOR COPY
9
I FOR1\-! #3 I
A request for a Purchase Order
REQUISITION
Date of request:
Required dale for delivery:
G--~~~
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CITY OF
ASHLAND
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Vendor Name
Address, City, State, Zip
Contact Name & Telephone Number
Fax Number
SOLICITATION PROCESS
D ExemDt from ComDetitive Biddina D Emeraencv
D Written Findings (Form attached) D Invitation to Bid (Copies on fiie) D Written findings attached
D Q~ote or ProDosal attached Date aooroved bv Council: D Quote or ProDosal attached
B" Small Procurement Coooerative Procurement
Less than $5,000 D Reauest for ProDosal (Copies on file) D State of Oregon
Note: Total contract amount, including any Date approved by Council: Contract #
amendments may not exceed $6,000 D State at Washington
Intermediate Procurement D Sole Source Contract #
GOODS & SERVICES D Written Findings (Form attached) D Other govemment agency contract
$5.000 to $100.000 D Quote or Proposal attached Agency
D (3) Written quotes attached Contract #
PERSONAL SERVICES D SDecial Procurement D Intergovemmentai Agreement
$5,000 to $75,000 D Written Findings (Form attached) Agency
D ~~ss than $35,000, by direct appointment D Quote or Proposal attached Contract #
D 3 Written orooosals attached Date aooroved bv Council: Date approved by Counal:
Description of SERVICES
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Item # Quantity Unit Descrip
Unit Price
Total Cost
D Per attached QUOTE
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AccountNumber'.!!:~_~'~?____n Account Number j~..~3_ll_3_n___
Proj~ct Number nnn. ___
Account Number ___. __. __. __' ______ Account Number ___. __. __' __. ______
'Expenditure must be charged to the appropriate account numbers for the financiats to reflect the actual expenditures accuretely. Affach extra pages if needed,
~%;~~:~:::,s requisition form, I certify that the infOrmatfOn;:Jided ive meets the City's public contractfng reqUirements'l)~e docu:ntatfon can be provided
Empl............~~ V ~ "'~.....H.... ....~./ ~
Additional signatures (if app icable):
Funds appropriated for current fiscal year: &:1 NO
Finance Director
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,
Date
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Comments:
G: FinanceIProcedure'APIFonns\Form #3 - Requisition,doc
Updated on: 611312011