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HomeMy WebLinkAbout2012-088 Contract - Versatile Concrete Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Versatile Concrete Construction Inc. ASHLAND CONTACT: Pat Harney 20 East Main Street'. Ashland, Oregon 97520 ADDRESS: P.O. Box 507 Telephone: 541/488-6002 Talent OR. 97540 Fax: 541/488-5311 TELEPHONE: 541-601-1261 DATE AGREEMENT PREPARED: 4-19-2012 FAX: BEGINNING DATE: 4-27-2012 COMPLETION DATE: 6-15-2012 COMPENSATION: $5,120.00 GOODS AND SERVICES TO BE PROVIDED: Reference Exhibit C: Request for Quotations sheet. ADDITIONAL TERMS:N/A 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 all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to$25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 279B.220, 279B.225, 2796.230, 279B.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$18,890 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 B predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses,judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Contractor(including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract). Contractor shall not be held responsible for any losses, expenses, claims, 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. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Contractor, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal, state, county or other sources is not obtained and continued at levels Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 1 of 5 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. Obligation/Liability 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, 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.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. 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 Compensation insurance in compliance with ORS 656.017, which requires subject'employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability 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 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. d. Notice of cancellation or change. 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 insurers to Contract for Goods and Services Less than $25,000, Revised 06/30/2011, Page 2 of 5 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 State of Oregon) and the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution, or otherwise, from any claim or from the jurisdiction. 18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT. CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: City of Ashland /� By By �1 ,r. Q. 4G FL Sig tuu Department Head rtieu r2. Print Nam— Print Name Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. `�c S�c.R O.1 lto= V��oe-ccRS covtta@w1.5a.'t�D�.t C6LSUO..s.,-LCE �S Ws.lvE.� a,�.`�� TM� Goic�o,�rtiL. �{qS ptD $wp�a-(EEC or-� £� ;r lz—°3 Qt>E� unto �.•v•a. Y.EP�-�ti �T• Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 3 of 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) 1 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. I/ (2) Commercial advertising or business cards or a trade association membership are purchased for the business. �C (3) Telephone listing is used for the business separate from the personal residence listing. �L (4) Labor or services are performed only pursuant to written contracts. V (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 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. - z Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/30/2011, Page 4 of 5 Exhibit C CITY OF ASHLAND REQUEST FOR QUOTATIONS Project is located on the north side of Ross Lane from Hillview Drive, westerly approximately 230 feet. The project includes construction of concrete curb and gutter and two driveway aprons as indicated below. All removal of existing concrete curbs and asphalt will be done by the City as will all base preparation, curb backfilling, and asphalt patching. The requested work will be for fine grading, forming, pouring, and finishing concrete curb and gutter and driveway aprons, and will include all necessary work not specifically listed as being provided by the City. Please indicate your unit price and total costs for each of the following items as indicated below. Item Description Qty Unit Unit Price Amount 1 Concrete curb and gutter 245 LF J�-- 3 ZO 2 6" Concrete apron 200 SF 6— ! 260 TOTAL PLEASE RETURN QUOTE BY: 2:00 PM, Wednesday April 18 2012 Date: L ^(,�._ / By: Si 7 - -ture �nntte arh P N Address: deC,�a�r Clem r—7% 97S1z6 ` 'me Phone: Sy/ – �B� (e Public Works Engineering Tel:541/488-5313 20 E.Main Street Fax:541/488-6006 Ashland,Oregon 97520 TTY:8001735-2900 www.ashland.or.us G:\pub-wrks%ng\12-03 Ross Lane Curb Relocation\12-03 RFQ Letter to Prospective Sidders.doc eecher Carlson 4/23/2012 10 : 45 : 33 AM PAGE 1/003 Fax Server ■ ■ BEECHER ,t; ARLSON Insurance Agency,LLC FAX TRANSMITTAL LAR4F9532B903E6 Date: 4/23/2012 10:45:02 AM Num of Pages: 3 (including cover) To: City of Ashland OR From: Larry Thompson Company: Direct Phone: (541)494-2657 Phone: Direct Fax: (541)772-3785 Fax: 5414885311 Email Address: larry.thompson @beechercarlson.com An Addtional Insured certificate for Versatile Concrete Const Inc M�} fry �J APR 2 4 20R 707 Murphy Rd. Medford,OR 97504 (541)772-1111 Main (541)772-3785 Fax CA License#OF09618 OR License#816307 WA License#252204 If ;-iit lul Ir ss'+I pl of drf II U ;curl is inl III r dal: Ir I IN I3,nl 1,11ED f'!al Ca,,I I i Ind 'J'o It r,-v mn 11:11 I I inlncCR[I I lhderl t,f ]-�r-rsc!I Jill r.?e-i 11 Irflkw i4!s Ilul I rtA tdatl r.+s ary u. . ,r,aiuI ii,i;hukon c.I c ipy_n? I Il n:. .: -i n,orwa l_I- -p eI:IL;41nc 1 t ,1j ha,c rce nI� id Ih-n 2r n td n r.-u',:n i I�-is 11 oy -I GJ,e s i UI11•tt;-s'mrlar In'n,c=di;.tr ur Il.1:c ur. and onturn Wo or 1a1a la IP ili:=Iran ml.,..l<.+:1 to It'o It' by U.S, ,pal Beecher Carlson 4/23/2012 10 : 45 : 33 AM PAGE 2/003 Fax Server ��O W PATE(MMIDn1Y.YYY). �.. CERTIFICATE OF LIABILITY INSURANCE 4/23/2012 _ _ THIS.OERTIFICATE IS ISSUED.AG-A-MAITER.OF-INFORMATON ONLY AND:CONFERS NO RIGHTS UPON THE CERTIFICATE: HOLDER. 714!S. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND UP.,,ALTER THE COVERAGE AFFORDED BY'THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE: DOES NOT CONSTITUTE A'CONTRACT'BETWEEN THE ISSUING:INSURER(S),. AIITHORIZED, REPRESENTATIVE OR PROOUCER,AND.THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an.ADDITIONAL INBURED; the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain.polirles may require an endorsement. A stMenniml on this certificate does not carrier rights lathe. certincate holder inaleu of such endorsement((s): PROCUCER. NAME:CONTACT.Larry'Thompson Beecher Carlson Insurance .Agency i,LC PHONE (Fq],')')72.-1111 PUC Na: IS 41)771-a7B5 707 Murphy Ad E. .lair -:the 'son @beechercarlson.core INSLRER(sI8FFORUIN3 COVERAGE' NAiCC- Med£ord. OR 97504 Irq,LnERAAta&rican Hallmark Ina-. Co of TX 4M94 INSURED 1NOURERU: Versatile Concrete Const -Inc INB64ERC: PO Box 507 IRGURFRa INBUgcRE: Talent OR 97540-0507 IRSURERF: COVERAGES CERTIFICATE-NUMBER:2011-12 Cert':s REVISION NUMBER: THIS.15 30 CERTIFY THAT THE POLICIES OF INSURANCE LISTED.BELOW HAVE BEEN,ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERiOD _ . . _ INDICATED. NOTVVITIISTAA'OING ANY REQUIREMENT. TERM OR CONDITION OF ANY C!YJTRACT OR OTHER'DOCUMENT'WITIi RESPECT TO WHICH THIS CERTIFICATE:MAY BE ISSUED OR MAY PERTAIN', 714E INS'URANC'E AFFORDED BY THE POLICIES UELICRIBEU HEREIN 1S'SUBJECT TO ALL THE'TERMSI EXCLUSIONS AN D CONDI TIONS'OF'SUCH POLICIES'..LIMITS SHOWN NIAY HAVE BEEN REDUCED BY PAID CLAIMS: I S TPEUNSUFUXE ICYEF P �CYE .POLIPY NUMBER O LIMIS GFNERAL LIAbIL'ry FF(::i OCCUeri=NCE 6 1,.000',ODU d. Cgnl,,l RC'L CEHdI•�L LI'Jd�Jf{" nt ni Ea UCa - f .100,1100 A. :tm,%ic-vvo rx.]sroJ'. &4rL44009006 9/14/2U11' 9/14;/ZUIZ IAFI` ,F'(A me pn 4 &,DUO -PERSor4Ai':RT]JlIAl11RS a :1;AUO,.000 . . . . . . . . . . GFNEwva,G4ec41e. . . .1, 2,000io0o N44GGRES,AT IUIr A-ruE.°.r_r, PP.LL r;.-COMF:UF A3C.♦; 2,000-,000 X. FOLIS'r M rFCr 71 -AUTOMOBILE LUb1U Y CLMON+n1 74—IL[10,111 1.0 0-UOU ANY AOTO BCDII f ir,➢iRYaPel A ALL ON.NFO l;HEDW.F.D 4CL44049006. 9/14/2011 3/14/2012 N 1T9� MX :k 1705 - BWI4Y IN,lUFI'iPer aa.f03rU Y X . PTTddE^ F'r CAOn DV+W:Gf .11 RED AUT05 ALOS i — .T :PIP-ba'IC i vtetutor UMBRELLA LAB: LI�CLIF. ._y;yo CCL+RRENCE 1 EXCESS LIAR EC F-E41 ION' $ WOR✓ERS COMPEN5AT10N \W STfiU-. OTff - ANDEMPLOY=nS:LIABILITY Y/.,1 Al PROWlq MRPAR PtFi'._FECl11 VE '0 E.l. E! F-4".CIU'cNT S O Fl [ AJ✓DEa4 w[ra: '� N/A . . . . . . . _ (Mandatary lnJJIU FI...D ffEA -EA.MPI01'=. S if,Ail 2�c6ilie dndrr ZESY45fO';OF CUERATf6l.S F.oiw E:L.OISFAac.-oQ1ICY LMdII' f [PE mPrONGFOPGRATONt/LOC.ATION9/VEHICLE9 (AkicM1ArOIEniDI AddA'onal Relr kc Rcnadul/;lFm vp ciJCiiq 'id) Certificate holder lncl'uded as additional inmurod a. res act acncY�l �- re p .amiability whorascquized by 'wr•ittcn: contract. This forts is: subject to policy terms, conditions-, and: exclusions-. . . . . . . . . . . . . CERTIFICATE HOLDER CANCELLATION -- (541)-4 B U-5311 SHOULDANY OF.THE ABOVE DESCRIBED POLICIE:.BE CANCELLED BEFORE. THE. EXPIRATION DATE THEREOF„ NOTICE'-WILL BE: DELIVERED IN City of Zishland: ACCORDANCE.WITH THE POLICY PROVISIONS. 20 B.Main. St. Ashland, OR 97520 AIITHORZCi3 P.EPRESEM1TgJ1VE L&=y Thompson/LARRY' ACORD 25(20110105): (,19RB.2g10 ACORO CORPORATION. All riyHts reserved. INS025.(2mniL)Ot The ACORD name and logo are registered marks of ACORD. 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Thanks, Scott A. Fleury, Engineering Services Manager City of Ashland, Public Works 20 East Main Street, Ashland OR 97520 (541) 552-2416, TTY 800-735-2900 Fax: (541) 488-6006 This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records Law for disclosure and retention. If you have received this message in error, please contact me at (541) 552-2417. Thank you. i arY RECORDER Page 1 / 1 �. C I T Y OF . DATE -` ;_PO NUMBER ASHLAND 20 E MAIN ST. 1 5/7/2012 10855 ASHLAND, OR 97520 (541)488-5300 VENDOR: 001079 SHIP TO: Ashland Public Works VERSATILE CONCRETE, INC (541)488-5587 P O BOX 507 51 WINBURN WAY TALENT, OR 97540 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req. Del. Date: Contact: Scott Fleury Special Inst: Confirming? No _quanti G.Unit Description . :. - Unit Price Ext.Price 245' of Curb and Gutter Replacement 5,120.00 200 Sq Ft Apron Addition Contract for Goods and Services Beginning date: 04/19/2012 Completion date: 06/15/2012 Insurance required/On file SUBTOTALI 5120.00 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 5,120.00 ASHLAND, OR 97520 Account Number' 'I -Project Number. `; Amount Account Number;:. Project Number Amount E 260.08.12.00.704200 E 201203.999 5,120.00 Authorized Signature VENDORCOPY IFORM #3 ��� � C I T Y OF A reques4 fora Purchase Order ASHLAND REQUISITION Date of request: .c(zs zerZ Required date for delivery: Aspr"z Vendor Name ct��tSR2utRaJ Address,City,State,Zip Q,o. eOIG So} "lau+crtT" oe. • `L: Sob Contact Name&Telephone Number pdi �tAQrvt`Y yy S41 —foot — m(a I Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract# ❑ Verbal/Written quote(s)or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) ❑ Other government agency contract $5,000 to$100,000 ❑ Written quote or proposal attached Agency f) (3)Written quotes attached ❑ Special Procurement Contract If PERSONAL SERVICES ❑ Form#9,Request for Approval Intergovernmental Agreement $5.000 to$75.000 ❑ Written quote or proposal attached ❑ Agency ❑ Less than$35,000,by direct appointment Date approved by Council: Date original contract approved by Council: ❑ 3 Written proposals attached Valid until: Date (Date) Description of SERVICES Total Cost 2451 t)E GGuzO .4 corm — St 1'2 ,oc� $ Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST Per attached quotelproposal $ Project Number 7Otl.. . 63 Account Number___-__-__- AccountNumber&o -QQ+ r2-a3-1-c`C2C�0 Account Number •__-__• - 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: ITDirector Date Support-Yes/No By si nin i Qui\sdion form,I certify that the City's public contracting requirements have been satisfied. y X- Employee Signature: \ Department Head Signature: \ 4t•C N(41.— YJ13��z (Equal to or greater than$5,000) Additional signatures(if applicable): Funds appropriated for current fiscal year: YES / NO Finance Director-(Equal toorgreaterthan$5,000) Date Comments: Form#3-Requisition