HomeMy WebLinkAbout2012-224 Contract - Renfro Striping & Sealcoat Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Renfro Striping and Sealcoat
ASHLAND ' CONTACT: Seal Coat/Crack Seal
20 East Main Street
Ashland, Oregon 97520 ADDRESS: P.O. Box 1334 Phoenix OR 97535
Telephone: 541/488-6002
Fax: 5411488-5311 TELEPHONE: 541-944-0953
DATE AGREEMENT PREPARED: FAX: 541-512-1773
BEGINNING DATE: September 7, 2012 1 COMPLETION DATE: September 21, 2012
COMPENSATION: 23,637.65
GOODS AND SERVICES TO BE PROVIDED: Crack Seal, Seal Coat and Striping Oak Knoll Golf Course,
YMCA and Hunter Park
ADDITIONAL TERMS:
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, 279B.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 $19,494 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:
If Cit fundin from federal, state, county or other sources is not obtained and continued at levels
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 1 of 6
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 06/30/2012, Page 2 of 6
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.
Contract City of Ashlan
By l By
Signature De art ment Head
Print Name Print Name
ILI L
Title Date
W-9 One copy of a W-9 is to be submitted with 5)
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 3 of 6
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.
(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) 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.
9-7-/Z
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 6
to: rage<m r <u l<-u»ur 1u:ao:w lee l IODOLOI9e<O room:mlam awne
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A ° CERTIFICATE OF LIABILITY INSURANCE "T0`"0711 Y""'
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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 THE 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: N the certificate holder is an ADDITIONAL INSURED,the poficy(ies)must be endorsed H SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an ax I rsemenL A statement on this certificate does not confer rights to the
Certificate holder in fieu of such erdorsem nd(s).
PRODUCER 54179-2667 OGIITACT
Redwoods Leavitt bus.Agency PPNOKE FAR
CA Lic NOC66788 W N^
122 NE Beacon Dr. EawL
Grams Pass,OR 97526 ADORas.
Samantha Fedosky cusTmrM0rRENFR-1
ustfamm AFFORreC covsaAsE "C II
INSURED Renfro Striping&Sealeoat IMURERA:American States Insurance Co. 19704.
Timothy Renfro DsIwER a:SAIF Corporation 36196
PO Box 1334 NSUREa c:
Phoenix.OR 97535
MAII®i D
erS11RERE:
dSORERF:
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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAX PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY WAVE BEEN REDUCED BY PAID CLAIMS.
lMTp TTP MSJRANCE POLICT MI m PM=EFF POIJCTE Lams
GENERIa LIABILITY EACH OCQRRENCE S 1,000,00
A 07H1 p 5 ,�6 200,00
aAIASAU� ❑X oaam A®E)P(MyMMpIFS®) s 10,000
PERSO YRAADVINJURY S 1,000,00
GENERAL AGGREGATE S 2,000,00
GEM AGGREGATE WIT APPLES PER PRODUCTS-CD►PWAGG f 2,000,00
POUC!
PRO-
--1 LOC f JECF F-1
AUTOMOBILE DABIDTY CGA6FIED SINGLE La1TT f.
• (EeafaOMlU
ANY Allm BOOLY NLRY Dbr person) S
ALL OrIFED AUTOS
BOOLY IN.YRY WY�) S
SCHEDULED AUTOS PRDPERTY DAMAGE
FIRED AUTOS (Pascad"4 f
NON OYAED Autos S
f
UMBRF1u LMB OGdm EAM OC.CU2RBME f
ERGE55 LMa CLAtASMADE AGGREGATE S
DEOMMULE f
RETENTION S S
wOinI COMPENSATION
II NOEMPLOYERSLM®LIT TORY UT ER
B ANY PROPRETOR/PMmERIIE =CNNE YIN 887556M 07101/12 0701„3 El.I=.101aCODETT s 500,00
OFFICERAIEM3ER EXCLUOEDT MIA
DleYatWIDNM E-L DISEASE-EA EMPLOYEE S 500,00
nyes JesrriDe MNM
IEBCRP110N DF OPERR71Dn6 aemN El-DISEASE-POLICY UNIT f 500,00
DESCRIPTION OF OPERNTIONS I LOCATIONS InHIMES A ACORD M.MAw.nM IMPMb S wtnW,a on V.b r Wr.Q
C of Ashland and Its elected oNLcWh errs and a es are named
ad Ronal insured In regards to general Ilab00y per form CCA6741207 per
written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Street
Ashland OR 97520 AUMOR J W RtiRPS9nATNE
c
CJ
®1988-2009 ACORD CORPORATION. AN rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
Commercial Certificate of Insurance FARMER s
Agency . Brian Gabaldon
Name . 1361 Center Dr# 100 Issue Date (MM/DD/YY) 09/10/2012
& • Medford,OR 97501-7938
Address • 541-734-2300 This certificate is issued as a matter of information only and confers no rights
upon the certificate holder.This cati8cate does not amend,extend or alter the
St. 73 Dist 01 Agent 363 coverage afforded by the policies shown below.
Companies Providing Coverage:
Insured Tim Renfro �pany A Turk Insurance Exchange
Name . Renfro Striping&Sealcoat lc..i y B Farmers Insurance Exchange
& • 1305 Pacific Lane com„ary C Mid-Century Insurance Company
Address • Phoenix,OR.97535 a
company D
trn�r
Coverages
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 requirement,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.
Co. T of Insurance Policy Number Policy Effective Policy Expiration Policy Limits
Ln. Yl� cY Date mmiDrimy) Date mm/DD/M cy
General Liability General AgVWte $
Commercial General Products-Comp/OPS
Liability Aggregate $
Personal&
Occurrence Vernon Advertising Injury $
Contractual-Incidental Each Occurrence $
Only Fire Damage -
(Any one fire) $
Owners&Contractors Prot. Medical Expense
(Any one person) q
C Automobile Liability 605132779 09/10/2012 09/10/2013 Combined Single
All Owned Commercial Lmm�t $300,000
Autos Bodily I j"�
X Scheduled Autos p P�n1 $
Hired Autes i �i u. =
Non-Owned Autos
Garage Liability I - Prop"Damage $
Garage Aggregate $
Umbrella Liability Limit $
Workers'Compensation Statutory
and Each Accident s
Disease-Fan,Empk yee $
Employers' Liability Disease-Policy limit $
Description of Operations/Vehicles/Restrictions/Special items: _
The City of Ashland,Oregon and its elected officials,officers and employees are listed as additional insured per attached form.
Certificate Holder Cancellation
. City of Ashland Should any of the above described policies be cancelled before the expiration date
Name . 20 E Main St thereof;the Issuing company will endeavor to mail 30 days written notice to the
& . Ashland,OR.97520 certificate holder named to the left,but failure to mail such notice shall impose no
Address obligation or liability of any kind upon the company,its agents or representatives.
Authorized Reoscifntative
5e-2492 "-era - Copy Distribution:Service Center Copy and Agent's Copy H-0n
POLICY NUMBER: 605132779 BUSINESSOWNERS
BP 04 50 0197
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
Name Of Person Or Organization:
City of Ashland,Oregon and it elected officials,officers and employees
20 E Main St
Ashland,OR.97520
Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Decla-
rations.
The following is added to Paragraph C. Who Is An
Insured in the Businessowners Liability Coverage
Form:
4. Any person or organization shown in the Schedule
is also an insured, but only with respect to liability
arising out of your ongoing operations performed
for that insured.
BP 04 50 0197 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑
Sep 0412 08:40a Renfro Striping 5415121773 p.2
R€Nmv miriwo & sEALcoAT PROPOSAL
P.O. BOX 1334
PHOENIX, OR 97535 DATE: 9/112012
(541)512-1773 /cell (541)944-0953
FAX(541)512-1773 JOB.# SEAL COAT / CRACK SEAL
CCB9 170604
FOR: ASHLAND PARKS AND REC. CONTACT: BRUCE DICKENS
CITY OF ASHLAND
FAX 541488-5314
Description of work to be performed:
CRACK SEALING:
CLEAN ALL CRACKS 1/8t' in. AND GRATER WITH HIGH BLAST
AIR COMPRESSOR, FILL WITH HOT RUBBER AND SQUEEGEE
FLAT.
SEAL COATING:
CLEAN THE PARKING LOTS BY BLOWING THE SURFACE AND
WIRE BROOMING TO ASSURE BONDING OF THE SEALCOAT.
APPLY TWO COATS OF A-100 ARMOR SEAL .
RESTRIPE PARKING AREAS AS EXISTING.
A. OAK KNOLL PARKING LOT
CRACK SEALING LUMP SUM $850.00
SEAL COATING 41,647 sq.ft 50.21 sq.ft. $8,745.87
B.YMCA PARKING LOT
CRACK SEALING LUMP SUM $400.00
SEAL COATING 27,858 sq.ft. $0.21 sq.ft. $5,850.18
C. HUNTER PARK PARKING LOTS
SWIMMING POOL LOT CRACK SEALING LUMP SUM $400.00
SEAL COATING 11,400 sgft $0.22 sq.ft. $2,508.00
TENNIS COURT LOT CRACK SEALING LUMP SUM 5400.00
SEAL COATING 20,380 sq.ft. $0.22 sq.ft $4,483.60
TOTAL BID: $ 23,637.65
TOTAL BID PRICE: $23,637.65
Bid Approved By :
Date:
Any Questions Contact TIM RENFRO @ (541)944-0953 THANK YOU,
Your Business is Appreciated.
CITY RECORDER Page 1 /1
Ashland Park Commission DATE PO NUMBER
20 E MAIN ST. L 9/17/2012 00146
ASHLAND, OR 97520
(541)488-5300 G2�,yr4!�%
VENDOR: 004051 61e'e-w-t" SHIP TO:
RENFRO, TIMOTHY WAYNE 'l��„ r
4855 SO PACIFIC HWY
PO BOX 1334
PHOENIX, OR 97535 '4
FOB Point: . Req.No.:
Terms: net Dept:
Req.Del.Date: contact: Bruce Dickens
Special Inst: Confirming? NO
Quantity Unit Description UnR Price Ext.Price
Crack Sealinq, Seal Coatinq &Stripinq 23,637.65
Parking Lots
Oak Knoll $9,595.87
YMCA$6,250.18
Hunter Park$7,791.60
Contract for Goods and Services
Beqinninq date: September 7, 2012
Completion date: September 21, 2012
Insurance required/On file
I
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1
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i
i
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i
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i
SUBTOTAL 23637.65
.L TO: TAX 0.00
FREIGHT 0.00
TOTAL 23,637.65
Account Number Project Number. Amount Account Number Project Number, Amount
411.12.00.00.70420 E 000017.999 7,791.60
411.12.00.00.70420 E 000019.999 9,595.87
411.12.00.00.70420 E 000026.999 6,250.18
Authorized Signature VENDOR COPY
FORM #3 CITY OF
a4i requvslfor a Purcrii µ3es arlf'fi ^," ASHLAND
REQUISITION Date of request: q 12-) t 2-
Required date for delivery: 11114112—
Vendor Name FV-71 FtZ0 S 11P I (2L4'1[2C 'Sea I
Address,City,State,Zip pQ P)N 15e2,L< Oe4y oe OK q 7S?�S
Contact Name&Telephone Number �`r`r —
Fax Number -
'S"12 - 177
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergencv
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) El Form#13,Written findings and Authorization
❑ AMC Z50 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 Dale approved by Council: Contract#
❑ Verbal/Written quote(s)or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Applicable Form(#5,8,7 or 8) ❑ Other government agency contract
$5.000 to$100,000 ❑ Written quote or proposal attached Agency
❑ (3)Written quotes attached ❑ Form#4, Personal Services$5K to$75K Contract#
PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement
$5,000 to$75,000 ❑ Form#9,Request for Approval ❑ Agency
❑ Less than$35,000,by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3)Written proposals attached Dale approved by Council: (Dale)
❑ Form#4, Personal Services$5K to$75K Valid until: Date
Description of SERVICES Total Cost
ors (L ock s
' IfnCA 18 ]; le - 60r0S15T72IPe- _
t[U/nle>z.PWk 77gi . C �
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
,TOTAL'COST
❑ Per attached quotelproposal $; ;
Project Num6er� -C1/G- 1L���Sr-g� Account Number___•_._- - - '
Account Number`bI - ILCO-pO- -Za1JZC0 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:
IT Director Date Support-Yes/No
By signing this�requisit' nn form,I certify that the City's public contracting requirements have b an satisfied.
ature: /
Employee Signature: K� � ! J��L� J Department Head Sign -
(Equal to or greater than$5,000)
Additional signatures(if applicable): J
Funds appropriated for current fiscal year YE / NO >A w K l [ 1
Finance Director-(Equal to orgreater than$5,000) Date '
Comments:
Form#3-Requisition - -