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HomeMy WebLinkAbout2012-284 Contract - Bartlett Tree Service Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Bartlett Tree Service ASHLAND CONTACT: Mike Bartlett 20 East Main Street Ashland, Oregon 97520 ADDRESS: 2288 Old Stage Road, Central Point, OR 97502 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-779-6067, 541-601-6780 DATE AGREEMENT PREPARED: November 15, 2012 FAX: BEGINNING DATE: November 26, 2012 COMPLETION DATE: June 30, 2013 COMPENSATION: Per fee schedule attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Arboricultural services to be provided on an on-call or as needed basis, including situations requiring immediate attention, as determined by a representative of the Ashland Parks Department per ITB attached as Exhibit D. 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 2796.220, 2796.225, 2798.230, 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 i written notice to Contractor, or at such later date as may be established by City under any of the following conditions: Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 1 of 5 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 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 Contract for Goods and Services Less than $25,000, Revised 06/3012012, Page 2 of 5 a 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 Ashla d By By Signature Department Head /'~IkC-2 Print Name Print Name o~&Z_/~ (c(zVla- 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 06/30/2012, 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 s 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: ri M6 (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. Wl (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. ni3 (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. !I z7 20 I2- Contract r (Date) Contract for Goods and Services Less than $25,000, Revised 06130/2012, Page 4 of 5 ..~v...wN ~m uvu i i V= wi v 1.= 041-//tl-OU P.1 r • ,rGc,c ~i.~ "Leaf it to us" SARTLETT (541) 779-6067 or (541) 601-6780 r/2EE SERVICE Certified Arborists on staff Licensed • Bonded • Insured 1 I CCB# 114906 )ate: 7 1J INVOICE KESTIMATE U RECEIPT ,ustomer:_Cr~ Y- o sMaA d - -Fad(- Y$$- S 31 O UAN. DESCRIPTION L AMOUNT O ` ; rr>' ~ In ' T OS•6c 11 f~h'lan_cr-{ Ni rUn'( .-~d' LtC /1nG 3r) ' °6~<7 ! = Z-/>uti r z p I ,rle~ - 2' 3cte rN e~, 2©O'`G hr. _ -hun e u- t - SSO 'lx H d(,tm iIii-AltYL .f ; 3Sc `fx d. dNM uc~ DD••~/!~r•, _ ~-hun o~- ~ - BrG~ar~Cllr .ems G-Xeti V e >u f" " M6rbor~- a er 70D'e~ err. 7_vnc.t u r C, +.k- 2s-6t1 rer " te- c ~r . S KM r' If ~ urn <'n t'~2r I Ole : rizr1 ii-in wcie - r-3so ~ra~~eC~ Kra T exCCbw% , /ZL Lr1C r Lt aR-tAG-~ I S kI d S e AqAd lastted ln- tail m I 5 2erL ~O /.l rr7 /1. ~ 0.r Qc..1' {t a~ o 1 Fc 1 auP oM p- Crew 1~J1` a a-S51,0. r- r----e5• ?hank /}'OU. Your Business is Appreciated. TOTAL Client Signature CITY OF Foxes #2 ASHLAND INVITATION TO BID - ARBORICULTURE SERVICES Release date: November 1, 2012 Requested by: Anne Thayer, Horticulturist Ashland Parks & Recreation Phone: 541488-5340 Fax: 541488-5314 Email: thayera@ashland.or.us Bids are due by: 1:00pm (PST), Thursday, November 8, 2012 Bids may be faxed, emailed or hand delivered. Vendors shall submit their bid on company letterhead. Informal email bids and/or late bids will not be accepted. Terms or discounts which are conditioned upon payment within a certain time will not be considered for purposes of comparison of bids. The successful contractor will be required to enter into a contract with the City for the services and provide insurance certificates in their own name for General Liability, Automobile and Workers' Compensation. Subcontracting will not be permitted. ON-CALL ARBORICULTURAL SERVICES Ashland Parks and Recreation intends to contract with a single contractor for on-call arboricultural services as listed below for the balance of the current fiscal year (July2102-June 2013). The total amount for these services is not to exceed $5,000 for the term of the contract. These services will be provided on an on-call or as needed basis, including situations requiring immediate attention as determined by a representative of the Parks Department. All pruning shall be done in accordance with the Tree-Pruning Guidelines of the Western Chapter of the International Society of Arboriculture (a copy on file at Ashland Parks and Recreation Department)., and /or the ANSI A300 Pruning Standard (American National Standard for Tree Care Operations) and adhere to the most recent edition of ANSI Z133.1. Please provide firm hourly rates for the following services and confirm that the pricing will be valid until the contract expires on June 30, 2012: 1. Pruning & Debris Cleanup 2. Pruning, No Cleanup 3. Tree Removal & Cleanup 4. Tree Removal, No Cleanup **Note: Each job will be discussed in advance andspecs will be determined at that time** Mellrod ofAward: ORS 279B.070 Intermediate Procurements. (4) If a contract is awarded, the contracting agency shall award the contract to the offeror whose quote or proposal will best serve the interests of the contracting agency, taking into account price as well as considerations including, but not limited to, experience, expertise, product functionality, suitability for a particular purpose and contractor responsibility under ORS 279B.110. Form #2 - Intermediate Procurement, Invitation to Bid/Equipment, Page I of 1, 11/15/2012 SAIF Corporation 11/15/2012 3:55:03 PM PAGE 1/001 Fax Server www.saif.com OREGON WORKERS COMPENSATIOQ,saif CERTIFICATE OF INSURANCE corporation CERTIFICATE HOLDER: CITY OF ASHLAND ATTN:CARRIE 90 N MOUNTAIN AVE ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by the policy described herein is subject to all the terms, exclusions and conditions of such policy. POLICY NO. POLICY PERIOD ISSUE DATE 733779 01/01/2012 to 01/01/2013 11/15/2012 INSURED: BROKER OF RECORD: MICHAEL BARTLETT _ MIKE BARTLETT TREE SERVICE 2288 OLD STAGE RD CENTRAL POINT, OR 97502-1352 LIMITS OF LIABILITY: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit - DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: Additional insures City of Ashland IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. This certificate does not constitute a contract between the issuing insurer, authorized representative or producer and the certificate holder. AUTHORIZED REPRESENTATIVE 3r9?e!P,- P iZ President and CEO 400 High Street SE Salem, OR 97312 P: 800.285.8525 F: 503.373.8020 Pollcy_8 Ich Certlflcate flnsurence NOV/15/2^012/THU 05:48 PM BEECHEN CARLSON INS. FAX No,541 774 8534 P.001 ® bYTE(MM/DOIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/15/2012 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 pollcy(les) 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 andorsement(s). PRODUCER - NAME T Pam Breazeale Beecher Carlson Insurance Agency LLC P"oHE ,p (541)494-2655 PAXN .(sAl).9A-2755 707 Murphy Rd E-MAIL am-breaz eale@beechercarl son. cam INSURER b AFFORbINGCOVERAGE NMC R Medford OR 97504 INSURERA:AMOrican Fire 6 Casualt Co 4066 INSURED INSURER e : Mike Bartlett, DBA: Mike Bartlett Tree Service INSURER c: 2288 Old Stage Road INSURER D: NSURER E: Central Point OR 97502 INSURER F: COVERAGES CERTIFICATE NUMBER:11-12 GL BA 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 TYPEOFINSURANCE POUCYNUMBER MNLICOYEFF POLICY EXP LIMITS LTR GENERALLIAeILITr EACHOCCURRENCE S 11000,000 A A RENTED X COMMERCIAL GENERAL LIABILITY PREMISES $ 100,000 A CLAIMS MADE OCCUR X 1rA1254106717 12/21/201112/21/2012 MED EXP An one er S 15,000 PERSONAL6ADVIWURY S 1,000,000 GENERAL AGGREGATE $ 2, 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CAMP/OP AGG S 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY -FOMBINED SINGLE LIMB 1,000,000 (Ea $ A ANY AUTO BODILY IWURY(Par peROn) S ALL OWNED X SCHEDULED AA1254106717 12/2112011 2/21/2012 BODILY INJURY (Per accident) S AUTOS M RED AUTOS t1AOON SWNED PROPERTY DAMAGE S Per accident X Medical mtnle S 5 000 UMBRELLA LINE OCCUR EACH OCCURRENCE 5 UCESS LIAS CLAIMS-MADE AGGREGATE S OED RETENTIONS S WORKERS COMPENSATION WG STATV- OTH. Y LIMITS PR AND EMPLOYERS' UASILITY YIN ANY PROPRIETORIPARTNERIERECUTIVE❑ NIA E.L. EACH ACCIDENT S OF"IrEwry~N~ fXGLUDED7 E1~p16EASE-FiA ENPLOYE S II r' , tleacfib under belb~ OCRIPTIONOFOPF3iAT10N E.L. DISEASE-POLICY LIMB S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AIDeh ACORD 101, Aadle.nel Remade S.hed.I.. If Ter. epee. ie 1".4ed) General Liability Policy includes Blanket Additional Insured coverage as required by written contract per form # CG8811 (10/09). This form is subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION (541) 488-5320 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Carrie 9 N Mountain Ave AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Pam Breazeale/PAMBRB /d++cra'ffi'~' ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 t2oio05).01 The ACORD name and logo are registered marks of ACORD NOV/15/2012/THU 05:49 PM BEECHER CARLSON INS. FAX No.541 774 8534 P.002 COMW*RCIAL. GEN&RAL LIABILITY CG 8311 10 E9 THIS EN0014SEM ENY CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION i his endorsement Modifies insurance provlded.uneer the foi€o%(mv; COMMERCIAL GENERAL LIAB'!LITY COVERAGE PART t4d PF.k: SUBJECT PA NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY - ELEVATORS 2 EXTENDED DAMACrETO PROPERTY RENTED TO YOU. (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION S EXTENSION OF SUPPLEMENTARY PAYMENTS, • COVE)tAGES A AND 8 3 A11DITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMt€T 3 PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS, EXTENDED PROTECTION OF YOUR "UFAITS OF INSURANCE" 5 WHO IS AN INSURED - INECIDENTIAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN INSURED - 6 FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACaUIRED. ENTITIES FAILURE TO DISCLOSE HAZARDS.AND PRIOR OCCURRENCES 7 KNOWLE=DGE OF OCCURRENCI7, OFFENSE. CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY RMEFINED 7 EXTENDED PROPERTY DAMAGE 7 WAIVER OF TRANSFI~R OF RIGHTS OF RECOVERY AGAINST OTHERS TO US.. 7 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU 0201D Llborty IJlertoal lnswa'nca Company. All el9hU*m,40rved. f_G HE t 116 09 lit l .des annvrioh4od mouriel of Ineuransm semlms aftm too- wish Its oerroissim Pace 1 of 7 NOV/15/2012/THU 05:49 PM BEECHER CARLSON INS. FAX No,541 774 8534 P. 003 with respect to coverage afforded by this endorsement, the provisions of the policy.apply unless modified by the endorsement. A. NON-OWNED AMCKA r Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Ua wllty, exclusion g, Aircraft, Auto Or Wotercraft does not apply to an aircraft provided, 5. It Is not owned by any Insured;. 2, it is tilted, chartered or loaned with p trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating hor or him a commercial or airline pilot; and e. it is riot being used to carry persons or property for $ Charge. However, the insurance afforded by this provision does not apply It there is available to the insured other valid and collectible insurance; whether primary, excess (other than Insuranee•written to apply specifically in excess of this policy), candrigerri Oran any other basis, that would also apply tie the loss. covered under this provision. B. fO"WNEDWATC-ACRAPT ()nder Paragraph 2. Exclusions of Section I • fsovsrage A - Rodify injury And Property Damage Usbil'rty, Subparagraph (2) of exclusion g. Aircraft, Auto Or Ullatemraft is replaced by the following This exclusion does notapply to: (2) A watercraft you do not oven that is: (a) Less than 62 feat long; and (b) Not being used to carry persons or property for a charge; C. McPERTY DAMAGE UABIUTY - ELEVATORS t. Under Paragraph Z Exclusions of Section I . Coverage A - Body injury ttnd Property Damage Liabli- Ky. Subparagraphs (3), (4) and (6) of exclusion j. Damago To property do not apply if such "property damage" results from the use of elevetors. For the purpose of this provision, elevators do no include vehicle lifts. Vehicle Itfis are lifts or hoists used in automobileservice or repair operations- Z The following in added to Bectlon Iii` - Commecciai OonaraA Uablilty Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insumaco: The insurance afforded by this pfovtslon of this e;tdorsernentIs excess over any property Insurance, whether primary, excess, contingent or on any other basis. D. F.7MM)EQ DAMAU TO PROPERTY REWMD TO YOU-(Tenant's Property Damege) if Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: t. Under Paragraph 2. Exi;lusians of Section I - Cover*gbA - S ly Injutg and Property Vernon* 1,labliity; 8. The fourth from the fast paragraph of exclusion j. Damage Te t''roperty is replaced by the follow- ing-paragraphs (f), (3) and (4) of rids exclusion do not apply tO "property damage" other then damage by fre,.lightning, explosion, smoke or leekage from automatic fire protection system) te: Premises rented. to you for e' period of 7 or fewer consecutive day's; or (ii) Contents that you rantct lease as part of a premises rental or lease agreernard for a period of mate than 7 dsys, Paragraphs (f), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. 02010 Liberty R!utual Insurance Company. All rights rw4vqd. coin 11 10 09 tncludss copyrighted maburat of Ins)lranco Setviom. 6ffim Ina, With its permission, Page 2 of 7 NOV/15/2012/THU 05:49 PM BEECHER CARLSON INS. FAX No,541 774 8534 P. 004 A separate 14PI , of insurance applies to this average as described In Section III - Limits of Insurenos. b, The I a st, go rag raph of suhsoution R. Exclusions is replaced by xha followi rig, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from sutomatic f(re protection systems to premises while rented to you or temporarily occupied by you with permission of the owner, A. separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits of Inauranta. 2. Paragraph S. underScation III - limits of Inavrenco is replaced by the following: 0, Subject to Paragraph 5, above, the Damage To Prerritse£ Rented To You Limit is the rtiostwe will pay under 'Coverage A for damages because at "property damage" to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner 'or damage by fire, lightning, explosion, smoke or leakage from automatic protection sys- tems; or b_ Contents that you rent or lease as part of a premises rental or lease agroetnonL As regards coverage provided by this provision D. EXTENDED DAMAGE TOT PROPERTY RENTED TO YOU (Tanant a Property Damage)- Paragraph 9,a. of Definifians'is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifles any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while ranted to you or temporarily occupied by you with the permission of the owner, or far damage to contents of such premises that are included In your promises rental or lease agreement, Is not an "insured. contract". E, PAEMCAL PAYMENTS LKI EN510N If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accielen4 and F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 1, Under Supplementary Payffiants - Coverages A and B, Paragraph 1,b- is replaced by the following! b. Up to 23,000 for cost of bell fronds required because of accidents or traffic few violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies, We do not have to furnish these bonds. Z Paragraph I A. is replaced by she following: d. All reasonabie.expenses incurred by the insured at our request to assist us in the Investigation or defense of the claim or "suit",. including actual loss of earnings up to $500 a day because of time off from work. G, ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1, Paragraph 2, under Section fl -Who Is An Insured is amended to Include as an insured any person or organization whom you have agreed to add as an additional insured in a written contact, written agreement or permit, Such person or organization is an additional Insured but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" caused by: 02al0 uherty ilatual Insurance Company. M rights reser:od, CG 88 11 10 09 includes cr»yrlehtad material of (n'surenar Serviars Office Inc., with as permieslon. Page a of 7 NOV/15/2012/THU 05:50 PM BEECHER CARLSON INS. FAX No.541 774 8534 P.005 a. Your alts or omissions, or the acts or omissions of those acting on your behalf, In the performance of your on going operations for the additional insured that are the Subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "per- . lanai end advertising injury" is coinmitted, subsequent to the signing of such written contract or written agreement,; or b. Premises or facilities rented by you or used by you; or e. The maintenance, operation or use by you of equipment rented or teased to you by such person or organization; or d, Operations performed by you or on your behalf for which the state. or political subdivision has issued s, permit subject to. the following additional provisions; (S). This insurance does not apply to "bocilly injury", "property darnage", or "personal and ad- vertising injury" arising nut of the operations performed for the state or political subdivision; (2) This insurance does not amply to "bodily injury" or " prcperiy damage" inctuded within the "completed operations hazard (8) insurance applies to premises you own, rant, or control but only with respect to the following harsrds: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awninge, canopies, cellar entrances, coal hales, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar expo- sures; or (b) The construotion, erection, or removal of elevators; or (c) The ownership, maintenance, at use of any elevators covered by this insurance. with respect to Paragraph t.a. above, a person's or orgarttkation's status as an additional insured under this endorsement ends wham (s) AR work, including materials, parts or equipment futnlshed In connection with such work, on the project (other than service, maintenance or repairs) to be performed by of an behalf of the additional insured(s) at the location of the covered operations has been completed; of (2) That portion or `your work" out of which the injury or damage arises has been put to Its intenders use by any person or organization other then another contractor or subcontmotor engaged in performing operations for a principal ass part of the same project. With respect to Paragraph t.b.abova, a person's or orannbration's status as an additional Insured under this endorsement ands when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph t:¢. above, this.insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement appii:as only if the written contract or written agreement is signed prior to the "bodily Injury" or "property damage" We have no duty to defend an additional insured under this endorsement until we receive written notice of a "Suit'' by the additional insured as required in Paragraph b. of Condition 2. Duties in the Event Of Occunertac, Offensit, Claim Or Stitt under Section IV - Catntnarcial Genartrl L;ttabHOW CotxOi- tfons. 2, With respect. to the Insurance provided by this endorsement, the following are added to. Paragraph 2. Ex4=3ons, under Sevdon I - Coverage A - Bodily Injury And Propai ty Ditmoge t.tabllity; 0201QUbetty MUtuel Insurance Cornpaay. Ali rights MSdrjed. CG as 7110 02 Includm nattvriahted mutenol of Insurance Sarvimt Or bm Ina. With its uarvntssinn Acme 4 of 7 NOV/15/2012/THU 05:51 PM BEECHER CARLSON INS. FAX No.541 774 8534 P-006 I his I neursnce do®s not apply"' a. "Bodily injury" or "property damage" arising from the sote negligence of the 86dltionai insured, b. "Bodily injury" or "property damage" that occurs prior to you commencing Liparations at the location where such "bodily Injury" or "property damage" occurs. c. "Bodily injury" "property damage" or"➢Brsonal ar.0 advertising Injury" adding out orthe render- ing of, or the failure, to render, any professional archiitectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders,.changs orders or drawings and specifications; or (2) supervisory, inspection, architacturel Or engineering activities, d, "Bodily injury" or "Property damage" occurring after: (1) All work, including materials, parts or equipment furnishea in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insurod.(s) at the location of the covered operations has been completed; or [21 That portion of "your work" out .of which the Injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project, e. Any person or organization specificeily designated as an additional insured for ongoing operations by a separate AW31TIONAL IN$VREO -OWNERS, LESSEES OR CONTRACTORS gndorsament is- sued by us and rriede a part of this policy. H. PRIMARY AND NOWCONTRBUTORY ADDITIONAL. INSLIKED OUEN61O€tl ThIS provision applies to any-person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION Ill - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend- ed as follows: a. The following is added to Paragraph s. Primary insurance: If an additional insitred's policy has an Other insurance provision making its policy excess, and you have agreed €n 'a written contract or kartten agreement to provide the additional Insured coverage on a primary and noncontributory basis, this policy shell be primary and we will not. seek contribution from the additional €nsured's,pciicy fordsmagas we cover. J;. 'rho following is added to Paragraph b. Excess Insurances When a written contract or written agreement, other then a premises lease, facilities rental contract or agreement, an equipment rental or tease contract or agreement, or permit issued by a state or political subdivision between you and on additional insured does not require this insurance to be primary ur ptimary and non-j:pntributory, this insurance is excess over any other insurance for which the addi- tional insured.is designated as a ;lamed insured. Regordiese of the written agreement between you and an additional insured, this insurance is o7tcees over any other Irisureoce whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on ot;ser policies, 9. ADDITIONAL INSURED- EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person Or organization who qualifies as an additional insured under any form or endoraornent under this policy, ' 1, The following is added to'Condition 2. Duties in The Evont Of Occurrence, Offense, Claim or Suit 02010 Liberty Mutual In'sirrenoe Company- Ali rights reserved. rn art 11 in no Pace 6 of 7 NOV/15/2012/THU 05:51 PM BEECHER CARLSON INS. FAX No.541 774 8534 P.007 An additional Incured under this endoreement will no soon as praaticable. a. Give written notice of an "oocurrance" or an offense, that may result Ina claim or "suit" under thin insurance to via; b, Tender the defense and indemnity of any claim or "suit" to all insurers whom also have, Insurance available to the additional insured; and e Agree to make available- any ott=er insurance which the additional insured has for a loss we. cover udder this Coverage Part. d- We have no duty to delend or Indemnity an additionai insured under this endorsement imtll we rer"O.written noticeore "Suit" bytheadditional insured. The limits of insurance applicable to the additjonai Inured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declaratiorts of this uoliry and defined in Section Oil - Unfits Of Insurance of ibis policy, wbickever are less. These limits are inclusive of and not in addition to the lhnlts of insurance available lender this policy, r- Wi-I 4 I n AN IN-nURED- iNtIDEUTIAL MMXCAL M"FtS I MALPRACTtdE WHO IS AN INSURED FELLOW EhRPLOYEP EXTENSION- MANAGEMENT WPLOYEF28 Parajralih Za-(1) of Section 11-s Is An Insured it replaced with the following, (1) "Bodily injury" or "personal and advertising Injury": (a) To you, to your partners or members (if you area partnership ar jointvanture), to your members (if you are a limited liability company), to a co-"empiegem" while, in the course of his or liar errlpluy- ment or performing duties related to the conduct of your business, or to your other "volunteer workars" while performing duties related to the conduct of your business; (b) To the spoum, child, parent, brother or sister of that cw-"employee" or "volunteer wortr" as a consequence of paragraph (1j (a) above; (c) For which there Is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (bj above; or (d) Arising out of his or her providing br failing to provide professional health care services. Ifowever, if you are not in the buclnesc of providing professional health care eurvieee or providing profes- sional health cars personnel to others, or if coverage for providing professional health care ter- vices is not otherwise excluded by separate endorsement, this. provision (Paragraph (d)) does not apply. Paragraphs (a) and (b). above do not apply to "bodily injury" or "personal and advertising injury" caused by an "amployee" who is acting in a supervisory capacity for you_ Supervisory capacity as used herein means the "employee's" job re@ponaihElities seaignad by you, Includes the direct supervision of other "emplay- ts" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising Injury" arising out of their willful conduct, which Is defined as the purposeful or willful Intent to cause Nbodily Kum" or "personal and advertising Injury", or caused in whole or in part by their Im=jca- tlon by liquor or cantrolled Substance's. The coverage ptovided by provision J. IS excess over any other valid and collectable Insurance available to your "empioyae". K. NEWLY MRfdED OR ADDITIONALLY ACQUIRED ENTITIES paragraph 3. of Section li -Who Is! An Insured is replaced by the followins; Any orgenlzation you newly acquire or form and over which you maintain ownership or majority Interest, will qualify as a Norned Insured if there is no other similar insurance available to that organizatlon. Howeven a, Coverage Linder this provision is afforded' only until the expiration 91 the policy period in which the entity was acquired or formed by you: b. Coverage A does not apply to "bodily injury" or "property dsmage" that occurred before you acquired or formaci the organiaetion; and 02010 Li6eity Mutual bauumon Company. All dishis reservaii. CG us 11 10 N Iryoludes tonyrighred malmriel 0Insutanm Services of lm Ina., w th'tis parmissibn- pgage H' Of 7 NOV/15/2012/THU 05:52 PM BEECHER CARLSON INS. FAX No,541 774 8534 P,008 c, Coverage 0 does not apply to "parsonal and adve'rtisir.g injury" arising out of an offense committed before you ai!qulred or farmed the organization. d, Rocords and descriptions of operations must be maintained by the first Nomad lnsured, No person or organization Is an insured with respect to the conduct of any current or past partnership,,ioint venture or limited liability company that is not Shown as a Teamed irlsUred in the Declarations ol, qualifies for as an lmured under this provision L. FAILURE TO DISCLOSE RIAZARDS' AND PRIDR OCCURRENCES ljndar Section IV - Commercial General Liability Gonditicnu, the following is added to Conditfon S. Repro• sentations; Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose ail hazards or prior "eccurrences" is not Intentional. M. KNOWLEDGE OF OCCURREAICE, OFFENSE, CLAIM OR SUIT Under Section IV - Commumiai Gonarst Liability Conditions:, the foi€owinq is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any insured shalt not, In Itself constitute know€yJge uTthe Insured unless an Insured listed under f aragraph t. of section It - Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or "suits" shall have rer,eived such notice from'the agent, servant or "employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your polity will automatically provide the coverage as of the day the revision is effective In your stste, a, BODILY INJURY REDEFINED Under Section V - Definitions, Definition 3. is replaced by the following: 3, "'Bodily injury" means physical Injury, sickness or disesso sustained by a person. This includes mental anguish, mental injury, shock, frigtit or death that results from such physical injury, sirk- ness'or disease, P. EXPENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABIL6TY is replaced by the following: a.. Expoctoel Or Intended Injury. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. Thls exclusion does not apply io "bodily injury" w "property damage" resulting from the use of reasonable farce to. protect persons or property. 0- WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A. CONTRACT OR AGREEMENT WITH YOU Under Section Iv - Gommerclal General Liability Conditions. the following Is added to Condition S. Trans- fer Of RighIp Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we moko for injury or damage arising out of your ongairtg operations or "your work" done under a contract with that person or orgarizitian and included in the "produots-compfated operations hazard" ptavlde& 1. You anti that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person er organization'; and 2- The injury or damage occurs subsequent to the execution of the written contract or written agree- ment. 02077 Liberty MUTtrel Insurance Comparty. Ail rights reseryed. CG 88 11 10 09 includes copyrighted mareriat of Insurance Servioes' Office Ism;wit8 fps permission. Page 7 of 7 Page 1 / 1 Ashland Park Commission DATE. PO NUMBER 20 E MAIN ST. 11/30/2012 00184 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 004091 SHIP TO: BARTLETT TREE SERVICE 2288 OLD STAGE ROAD CENTRAL POINT, OR 97502 FOB Point: Req. No.: Terms: net Dept: Req. Del. Date: Contact: Bruce Dickens - Anne Thayer Special Inst: Confirming? No I Quantity Unit Description Unit Price Ext. Price Arboricultural services to be provided 5,000.00 on an on-call or as needed basis, including situations requiring immediate attention, as determined by a representative of the Ashland Parks Department per the attached contract for the balance of the current fiscal year. Contract for Goods and Services Beginning date: November 26, 2012 Completion date: June 30, 2013 SUBTOTAL 5 QQQ.QQ BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 5,000.00 Account Number Project Number Amount Account Number Project Number Amount E 211.12.02.06.60410 5,000.00 d'~ zv/L VENDOR Authori2 Ignature COPY FORM#3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: !l-1(D-%? Required date for delivery: Vendor Name I Address, City, State, zip as 6 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 uote or proposal attached Small Procurement Cooperative Procurement Less than $5.000 ❑ Request for Proposal (Copies on f le) ❑ 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 (3) Wdtten quotes attached ❑ Form #4, Personal Services $5K to $75K Contract # - PERSONAL SERVICES ❑ Special Procurement Intemovemmental 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 oh calk a4m ut6u9&rvlziys q-015,o~ T s a~lscaQ $ Item # Quantity Unit Description of MATERIALS Unit Price Total Cost e TOTAL COST?". ❑ Per attached cluotelproposal Project Number , Account Number Account Numbez3fI-~2- -QzC~-l3JfIQ~j 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 requis' ' n form, I ce tify that the City's public contracting requirements have bee fisfied. Employee Signature. Department Head Signature: qua[ to or greater than $5,000) Additional signatures (if applicable): Funds appropriated for current fiscal year., YES / NO Finance Director- (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition