HomeMy WebLinkAbout2012-227 Contract - Rogue Shred 1
Contract for GOODS AND SERVICES Less than $25,000 .
CITY O F CONTRACTOR: Rogue Shred, LLC
ASHLAND CONTACT: Mike Jacobson
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 8001 Table Rock Road, White City, OR 97503
Telephone: 541/488-6002 MAILING ADDRESS: PO Box 3187, Central Point, OR 97502
Fax: 541/488-5311
TELEPHONE: 541-779-4161, 541-210-6506
DATE AGREEMENT PREPARED: March 9,2011 FAX:
BEGINNING DATE: April 1, 2011 1 COMPLETION DATE: March 31, 2013
COMPENSATION: Fee schedule attached as Exhibit A is valid from April 1, 2011 until March 31, 2012. Fee
Schedule attached as Exhibit B is valid from April 1, 2012 until March 31, 2013.
GOODS AND SERVICES TO BE PROVIDED: Contractor to provide on-site document shredding, and
shredded material will be transported by the contractor to an appropriate recycling location. Services will be
performed on an as needed basis for City departments.
ADDITIONAL TERMS: Additional information, including photo of shred containers is attached as Exhibit C.
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$18,703 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50%or more of the work under this contract. Contractor is'also required to post the notice attached
hereto as Exhibit 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:
This CONTRrc- PLA be RT A)S .1m€ ± COnr,2AeToe. UFvtj 30 mjs
Contract for Goods and Services Less than$25,000, Revised 12/20/2010, Page 1 of 5
rwoTPe£ iw wwn)tJ daIiWAe4 41 cE(LTrf4 IR&IL Ov- rlL V"Zo,u. i�
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d)are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. 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 Liab" insu_.g
Q�e with a combined single limit, or the equivalent, o no I ac than Enter one:
$200,000, $500,000, $1,000,000, $x,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall inclu ntraettiial liability coverage for the indemnity provided under this contract.
C. Automobile Li bit -ip&u ce with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000 $1,000,000), or of Applicable for each accident for Bodily Injury and Property Damage,
including coverage for mied-Mir d or non-owned vehicles, as applicable.
d. Notice of cancellation or change. There shall be no cancellation material change, reduction of limits or
Contract for Goods and Services Less than$25,000, Revised 12/20/2010, Page 2 of 5
'intent not to renew the insurance coverage(s)without 30 days'written notice from the Contractor or its insurer(s)to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law;Jurisdiction;Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the 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
Byu /I By At;4
Signature Department Hea
�GYVF7E.z W Sr�tii�f LrGE. %uN�.s.�✓GG
Print Name Print Name
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 12/2012010, 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:
�r (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.
' r (2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
� S (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.
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 12/20/2010, Page 4 of 5
CITY OF e OREGON
EXHIBIT B
City of Ashland
LIVING
AGE
. -
per hour,effective June 30, 2010
(Increases annually every .Lune 30 by the`
Consumer Price Index)
Employees must . • Chas business of their cafeteria plans(including
living wage: if the employer has childcare) benefits to the
e employees, and amouiit of wages received by
ed financial the employee.
for the project or
➢ For all hours worked under a business from the City of ➢ Note: "Employee'does not
service contract between their Ashland in excess of$18,703. include temporary or part-time
employer and the City of employees hired for less than
Ashland if the contract ➢ If their employer is the City of 1040 hours in any twelve-
exceeds$18,703 or more. Ashland including the Parks month period. For more
and Recreation Department. details on applicability of this
➢ For all hours worked in a policy, please see Ashland
month if the employee spends ➢ In calculating the living wage, Municipal Code Section
50% or more of the employers may add the value 3.12.020.
employee's time in that month of health care, retirement,
working on a project or 401 K and IRS eligible
T,r additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
Contract for Goods and Services Less than$25,000, Revised 12/20/2010, Page 5 of 5
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Rogue Shredding
Rogue shredding is a company in Central Point. Their shredding service consists of six
different sized bins priced accordingly.
The company can come weekly, bi-weekly, or monthly. The shred is done on sight.
They offer to put together a policy and procedure at no cost to accommodate what
individual organizations will need. They would also provide education for staff on
shredding policy and.procedure.
After the items have been shredded they are shipped to Hallsy where they are pulped up
and made into Costco paper products.
Rogue Shred is able to shred hard drives, CD's, DVD's,plastic, and cell phones.
Paperclips and staples do not need to be removed in order to shred.
NOTE:
65 Gallon Shred Cart holds 250 lbs of paper
35 Gallon Shred Cart holds 125 lbs
40" Consoles hold 100 lbs
29" Consoles hold 70 lbs
Small Consoles for under desk $1.05 each
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ADDENDUM TO CITY OF ASHLAND
CONTRACT FOR GOODS AND SERVICES LESS THAN $25,000
Recitals:
A. On March 9, 2011, City of Ashland ("City") and Rogue Shred, LLC, an Oregon
limited liability company("Contractor") entered into a"City of Ashland Contract for
(goods and Services Less than $25,000" (further referred to in this addendum as "the
Agreement").
B. The parties desire to add to the Agreement provisions required by OAR 166-
30-060.
Agreements
City and Consultant agree to add the following provisions to the Agreement:
1. Contractor will secure handling, transit, and prompt obliteration of the public
records given to Contractor, including full obliteration of the contents and dates
of the documents.
2. Contractor will not transfer public records or other records given to Contractor by
the City from City offices and will not sell, transfer or deliver such records to a
third party,purposely or by mistake,prior to data obliteration. Data obliteration,
consisting of shredding, will take place at the City offices where the public
records are stored.
3. Contractor hereby undertakes and indemnities the City against any claims or
actions by third parties resulting from Contractor's failure to protect the
confidentiality of public records.
4. Except as modified above the terms of the Agreement shall remain in full force
and effect.
ROGUE SHRED, cITY OF ASHLAND:
an Oregon limited ffab7i '
By: ®y. A
oph/en r.8a' e,Authorized Member Department Head'
Date: LY! "trr l!
Ir
Purchase Order 0.
Acct:No.:
(For City purposes only)
1-CITY OF ASHLAND,ADDENDUM TO CONTRACT FOR GOODS AND SERVICES 425,000
• ROGUMAST
DATE PUUT1DNYYY)
ACC>R01 CERTIFICATE OF LIABILITY INSURANCE 9/28/2011
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 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: H the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
'3151TACT
PRODUCER NAME:
PHONE IMC No:
IAJC No.Wells Fargo Insurance Services USA,Inc ' E#AIL ) ' '!
ADDRESS,
975 Oak Street,Suite 900 INSURERS AFFORDIND COYERAGE "We
Eugene,OR 97401 INSURER A: Greenwich Insurance Company 22322
INSURED INSURER a: XL Specialty Insurance Company 37885 j
Rogue Waste Systems,LLC 36196
IxsuRERC: SAIF Corporation
PO Box 3187
NSURER D:
NSURER E:
Central Point,OR 97502 wsuRER F:
COVERAGES CERTIFICATE NUMBER: 3316617 REVISION NUMBER: See below
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.
WSR FOLICYEFF FOLmYEXP UNITS
TYPE OF INSURANCE POLICY NUMBER M
GENERAL MOMITY EACH OCCURRENCE f 1•�•�
A, GEC0035827 10/112011 10112012 .1
X COMMERCIALGENERALLIABILITY f 100,00D
CLAIMS.MADE OOCCUR MED EXP ov, ter S SCOW
X $1.(ODaVPDDaddd.
PERSONAL SADV INJURY $ i��•
GENERALAGGREGATE S 2•ODO•
GENT AGGREGATE LIMITAPMIES PER: PRODUCTG-COMP/°P AGG S Z•000.4_ ''
f
SEXCESSLM PRO. LOC
B UMHUTY AECO035824 1011/2011 10112012 °M WanlslN UMI 100D,0°S,'
BODILY INJURY(PW pen ) s
-
D SCHEDULED BODILY IWURY(Psr aeddsM) S _
NON-OWNED PROPERTY DAMAGE $IN,socid"O
TOS AUTOS S __(
d
A MB OCCUR EACH OCCURRENCE f
M CLAIMS-MADE AGGREGATE f -
f
OEO RETENTIONS X WC STATIF WORKERS COMPENSATION 519473 toll/2011, 10/12012
C AND EMPLOYERS'LNBILIrY mu'v0
ANY PROPRIETOWPARTNERIEXECIRWE YIDN EL EACH ACCIDENT S
OFFICEWMEMBER EXCLUDED? NIA 600.(p0
(MandMM in NH) F.L.DISEASE•EA 5MPLOWE f
U a.describe 9.0' E.L.DISEASE-POLICY LIMIT- $ 50.000 DESCRIPTION OF PEMTIONa Wbw
DEE CRIPTMOFOPERATION3ILOCATION3IVEHICLE4 (ANwNACORD 101,Add10ontlWmaha 9cNaduM.xmon yacabnpuln� - �,
The City of Ashland,Oregon and its elected officials,officers and employees are listed as additional insureds but only with respects to the services
provided by Rogue Shred,LLC.
e'
CERTIFICATE HOLDER CANCELLATION -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Mein St.
Ashland.OR 97502 AUTHORIZED REPRESENTATIVE
ge-44
The ACORD name and logo are registered marks of ACORD ®1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105)
Page 1 / 1 -
�. CITY OF
ASHLAND DATE PO NUMBER
rim ASHLAND,E MAIN ST. 9/18/2012 11180
ASHLAND, OR 97520
(541)488-5300
VENDOR: 013536 SHIP TO: Ashland Finance Deartment
ROGUE SHRED, LLC (541)488-5300
PO BOX 3187 20 E MAIN STREET
CENTRAL POINT, OR 97502 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.: _
Req.Del.Date: - Contact: Cindy Hanks _
Special Inst: Confirming? NO ..
-
Quantity ` Unit Description Unit Price'. Ext.Price
Document shredding for Accounting and 5,400:00
Purchasing
Contract for Goods and Services
Beginning date: April 1, 2011
Completion date: March 31, 2013
Insurance required/On file
SUBTOTAL 5,400.00
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00:
541-552-2010 TOTAL 5,400.00
ASHLAND, OR 97520
Account Number, Project Number Amount Account Number Project Number Amount ' --
E 710.03.08.00.60110 51000.00
E 710.03.09.00.601100 400.00
Authorized Signature VENDOR COPY
FORM #31 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: 19 11 1 1a-
Required date for delivery:
Vendor Name �� Z
Address,City,State,Zip
Contact Name&Telephone Number
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) ❑ Stale 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
❑ (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 F1 Written quote or proposal attached Date original contract approved by Council:
[1 (3)Written proposals attached Date approved by Council: (Date)
❑ Form#4, Personal Services$5K to$75K Valid until: Date
Description of SERVICES Total Cost
D�cumen� �1�red
d sec l n1 purc6lk�t $
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
•T6TA11fC6ST
❑ Per attached quotelproposal $
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Project Number______-___ Account Number_?I0- D36QY-DO- tIQD- SDUU � �`• -
Account Number - - - •______ Account Number-71b•6•0`t-bv _1001 icc)
`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 requisition form,I certify that the City's public contracting requirements have been satisfied.
r � \
Employee Signature: L ,� � Department Head Signature: �,t f�aJ Lk l� �`V! �
qual to or greater than$5,000)
Additional signatures(if a plicable):
Funds appropriated for current fiscal year: YES / NO
Finance Director-(Equal to or greater than$5,000) Date .
Comments:
Form#3-Requisition