HomeMy WebLinkAbout2012-276 Contract - Midco Diving & Marine Services
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Midco Diving and Marine Services Inc.
ASHLAND CONTACT: AJ Vela
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 7396, Loveland, CO 80537
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 970-744-2097, 800-479-1558 Ext. 87
DATE AGREEMENT PREPARED: October 5, 2012 FAX:
BEGINNING DATE: November 1, 2012 COMPLETION DATE: November 30, 2012
COMPENSATION: $2,599.00 per contractor's proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Commercial diving services to clean water plant clearwell
(holding tank for finished drinking water per Invitation to Bid and contractor's proposal attached as Exhibit C.
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 2798.220, 2798.225, 27913.230, 2798.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract. .I
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract `I
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:
- i. If City funding from federal, state, count 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 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 quality 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 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
"~r~QQ,~
Signature Depa m nt Head
Print Name Print Name
irr~r72 \ \ a (t Z I
Ole
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 06/3012012, Page 3 of 5
z
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.
~/6/
Contr for (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 5
Diving & Marine Services, Inc.
City of Ashland September 26, 2012
Attn: Greg Hunter
90 North Mountain Ave
Ashland, OR 97520
RE: 2012 Tank-Maintenance Project
Midco Diving & Marine Services, Inc. is pleased to provide the following proposal to perform the scope of work outlined
below.
All diving operations are fully insured for "Commercial Diving Operations" including General Liability and Workman's
compensation. Verifiable Certificates of Insurance are available upon request. Midco Diving & Marine Services, Inc. is
in full compliance with OSHA 29 CFR 1910, Subpart T - Commercial Diving Operations regulations: OSHA specifies that
the minimum acceptable dive crew size is three qualified divers. Not all firms are complying with this mandate and
continue to use two person dive crews or unqualified personnel; please be aware of this when evaluating our proposal.
Further, prior to commencing work, and if requested, we will provide your firm with copies of personnel and equipment
certifications which meet or exceed those mandated by OSHA, specifically;
Diver training - from accredited commercial dive school (each dive team member)
Association of Diving Contractors International (ADC) Commercial Diver Certification Cards indicating each dive team member's
qualifications and competency level as defined in the ADC Consensus Standards
Current First Aid/CPR training (each dive team member)
Annual medical examination determining diver is fit to perform assigned tasks (each dive team member)
Air purity test for breathing air source(s) - tested every 6 months -
Breathing gas supply hoses -tested at least annually to 1.5 times their working pressure
Depth gauges- calibrated every 6 months
TANK DESCRIPTION -
Concrete Clearwell
67'x67'x5'
Notes: Clearwell has 1 section 10'x 10' with 1" of sand deposit. Clearwell also has 1 section 10'x 30' with
soda ash deposits approximately 1' deep with 1" thick stuck on side wall.
800.479.1558
www.midcodiving.com
info@midcodiving.com
Home Office P.O. Box 513 Rapid City, South Dakota 57709 605-791-3030
Regional Office P.O. Box 7396 Loveland, Colorado 80537 970-744-2097
Inspection
An inspection with a live video recording will be made along with written documentation of all findings in the tank
in a written report. Inspection procedures include.
• Inlet and outlet . Exterior ladder & rails
Overflow • Sumps
• Roof and Roof hatch . Internal plumbing
• Walls and floors . Joints and seams
• Baffle/support walls • Interior coating
• Interior ladders • Telemetry
• Roof vents • Sediment depths
• Exterior coatings
Cleaning
Remove accumulated sediment as described by the City of Ashland using underwater vacuum procedures as
needed. Any material that cannot be removed by normal vacuum/nozzling procedures or material in excess of
what has been described above will be removed for an additional charge with a firm price given while on site.
Material such as sand, gravel and concrete is considered debris and will be removed by hand at an
additional charge. All discharged materials including water are the responsibility of the owner unless prior
arrangements are made.
Cleaning & Inspection Pricing $2,599.00
Any fees required to obtain a city business license will be added to the final invoice at the current city rate plus
appropriate markup.
This quote and pricing is valid for Thirty Days (30). Terms are net 10 days for completed on site work; interest at
1.5% per month on any unpaid balance. Pricing Is also contingent on utility personnel working with our
scheduling department to complete the project in timely and proficient manner which includes potentially working
over a weekend. Although we strive to work with utility personnel in regards to scheduling availability, some
instances necessitate weekend access. All Midco Diving quotes are subject to availability of personnel and
equipment; upon approval have this signed and faxed back to 800-238-0217 to confirm scheduling.
This quotation has been prepared exclusively for your firm. The contents of this quotation are considered
confidential and are not to be divulged to third parties. This quotation has been prepared using information
provided by your firm/utility. Incorrect or inaccurate information used for estimate purposes or that delays
progress could influence your final price. Interruptions in the work progression, not in control of Midco Diving &
Marine Services, Inc. may also affect your final pricing. If Midco Diving & Marine Services, Inc is unable to
complete the work as described above due to tank access, water levels, safety issues, etc. a nominal trip fee may
be charged.
Sincerely,
a~ vex
AJ Vela
Regional Sales Manager
Accepted by:
Name & Title Utility/Company Name Date
800.479.1558
www.midcodiving.com
info@midcodiving.com
Home Office P.O. Box 513 Rapid City, South Dakota 57709 605-791-3030
Regional Office P.O. Box 7396 Loveland, Colorado 80537 970-744-2097
s
acoR°® CERTIFICATE OF LIABILITY INSURANCE °A'E'MM,D°""Y"'
11/5/2012
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: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, 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 endorsements .
PRODUCER
CONT CT
NAME:
Fisk Marine Insurance International, LLC PHONE FAX
4404 ac Nc : 543-4619
PO Box 24071 504-302-
EWAIL
New Orleans LA 70184 ADDRESS:
INSURERS AFFORDING COVERAGE NMCC
INSURER A
INSURED M IDCD IV-01 INSURER B
2_
III Diving & Marine Services, Inc. INSURER C:
P.O. Box 513 INSURER D:
Rapid City SD 57709
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 2050417151 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 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.
INSR TYPE OFINSURANCE ADDL UBR POLICY EFF POLICY EXP
LTR INSR MD POLICY NUMBER MM/DDNYYY MM,DD/YYYY LIMITS
A GENERAL LABILITY V V MH 8915819-05 /26/2012 /2612013 EACH OCCURRENCE $1,000,000
x COMMERCIAL GENERAL LIABILITY AMA T R NT D
PREMI E Ea o TED $50,000
CI-AIMS-MADE OCCUR MED EXP(My me person) $5,000
X BRILL PERSONAL &ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $1,000,000
X POLICY PRO- LOC BRILL $1,000,000
JPCT
A AUTOMOBILE LIABILITY Y CAP 3066353 /26/2012 /2612013
Es accident 1000000
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED Ix SCHEDULED BODILY INJURY(PeraWdent) $
AUTOS AUTOS
NON-0WNED PROPERTY DAMAGE
X HIREDAUTOS AUTOS Per. idml $
$
B UMBRELLA LAB X OCCUR Y MUS334628-12-1 /26/2012 /26/2013 EACH OCCURRENCE 84,000,000
X EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000
TIED X RETENTION 825,000 $
C WORKERS COMPENSATION y 02799512179997221 /26/2012 /26/2013 X WCSTATU- X 0TH. USLH
AND EMPLOYER$'LABILTY YIN
ANY PROPRIETOR/PARTNER/EXECUDVE N/A E.L. EACH ACCIDENT $1,000,000
OFFICE11MEMBEREXCLUDED9
(Mandatory In NH) E. L. DISEASE - EA EMPLOYE $1,000,000
If yes, descree under
DESCRIPTION OF OPERATIONSNIO.v EL DISEASE - POLICY LIMIT $1,000,000
B MEL V V 110460 12612012 126/2013 Limits 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom space is required)
Certificate holder is listed as additional insured with a waiver of subrogation by virute of blanket additional insured and blanket waiver of
subrogation endorsements included in General liability, auto liability, maritime employers liability, and excess liability policies. Workers
compensation contains blanket waiver of subrogation as required by contract. Policies contain primary non-contributory endorsement and
general liability and excess policies contain completed operations coverage as outlined in above limits.
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 AUTHORIZED REPRESENTATIVE
1
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Page 1 / 1
CITY RECa1'?CE,
CITY OF
ASHLAND DATE PO NUMBER
20 E MAIN ST. 11/8/2012 11281
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 017421 SHIP TO: Ashland Water Treatment Plant
MIDCO DIVING & MARINE SERVICES (541) 488-5345
PO BOX 513 ASHLAND, OR 97520
RAPID CITY, SD 57709
FOB Point: Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Greq Hunter
Special lnst confirming? NO
Quantity Unit Description Unit Price Ext. Price
Clean drinkinq water plant clearwell 2,599.00
for circulation pump installation
Contract for Goods and Services
Beqinninq date: November 1, 2012
Completion date: November 30, 2012
Insurance required/On file
SUBTOTAL 2,599.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 2,599.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 670.08.19.00.70420 2,599.00
- thoi //2-VENDORCOPY
2 ure Authorized S ignat
FORM #3 CITY OF
A rquest for a 'Purchase Order ASHLAND
REQUISITION Date of request: 10-2-12
Required date for delivery: ASAP
Vendor Name MIDCO DIVING AND MARINE SERVICES INC
Address, City, State, Zip P.O. BOX 7396 LOVELAND, CO. 80537
Contact Name & Telephone Number. A.J. VELA 800-479-1558 EXT 87
Fax Number 800-238-0217
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form 913, 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
5 000 100 000 ❑ Written quote or proposal attached Agency
3) Written en quotes attached ❑ Form A, 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 Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
CLEAN DRINKING WATER PLANT CLEARWELL FOR CIRCULATION PUMP
INSTALLATION $ 2599.00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL. COST
® Per attached quotelproposal $ 2599.00
Project Number Account Number 670.08A9.00.704200
Account Number 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 si 'rig this re Qisl l form, I certify that the City's public contracting requirements have been satisfied.
Employee Signature: Department Head Signature: , dLo j . I t I Z
(Equal to or grea er t an $5,000)
Additional signatures (if appl able):
Funds appropriated for current fiscal year: YES / NO
Finance Director- (Equal to orgreater than $5,000) Date
Comments:
Form #3 - Requisition