HomeMy WebLinkAbout2019-255 20200214 HD Fowler Company
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GOODS AND SERVICES AGREEMENT LESS THAN 525,000
PROVIDER: H.D. Fowler Company
CITY OF PROVIDER'S CONTACT: Joshua Morrison
-ASH LAN D
20 East Main Street ADDRESS: 17 S. Stage Rd. Medford, OR. 97501
Ashland, Oregon 97520
Telephone: 541/488-5587 PHONE: 541-770-4432
Fax: 541/488-6006
Email: joshmo&dfowler.com
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This Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an
Oregon municipal corporation (hereinafter "City") and H. D. Fowler Company ("hereinafter "Provider"), for a 6"
Filtomat Filter.
1. PROVIDER'S OBLIGATIONS
1.1 Provide; Quantity; 1- 6" Filtomat #M106 XLP 050007-000164 200 micron 110V AC Electronic (plus
freight) as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference,
incorporated herein. Provider expressly acknowledges that time is of the essence of any completion
date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline
may be authorized except in the same manner as herein provided for authority to exceed the maximum
compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall
hereinafter be collectively referred to as "Work."
1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance
of all Work received hereunder, a policy or policies of liability insurance including commercial general
liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two
million dollars) per occurrence for Bodily Injury and Property Damage.
1.2.1 The insurance required in this Article shall include the following coverages:
• Comprehensive General or Commercial General Liability, including personal injury,
contractual liability, and products/completed operations coverage; and
• Automobile Liability.
1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and
shall:
• Name as additional insured "the City of Ashland, Oregon, its officers, agents and
employees" with respect to claims arising out of the provision of Work under this
Agreement;
• Apply to each named and additional named insured as though a separate policy had been
issued to each, provided that the policy limits shall not be increased thereby;
• Apply as primary coverage for each additional named insured except to the extent that two
or more such policies are intended to "layer" coverage and, taken together, they provide
total coverage from the first dollar of liability;
• Provider shall immediately notify the City of any change in insurance coverage
• Provider shall supply an endorsement naming the City, its officers, employees and agents
as additional insureds by the Effective Date of this Agreement; and
• Be evidenced by a certificate or certificates of such insurance approved by the City.
Page 1 of 5: Agreement between the City of Ashland and H. D. Fowler Company
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1.3 Provider shall, at its own expense, maintain Woxker's Compensation insurance in compliance with ORS
656.017, which requires subject employers to*ovide workers' compensation coverage for all of its
subject workers. I
1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status,
familial status or domestic partnership, natiopal origin, age, mental or physical disability, sexual
orientation, gender identity or source of income, suffer discrimination in the performance of this
Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of
federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees
not to discriminate against a disadvantaged business enterprise, minority-owned business, woman-owned
business, a business that a service-disabled veteran owns or an emerging small business enterprise
certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110.
1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be
performed under a subcontract, including pr Icurements of materials or leases of equipment, each
potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under
this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws.
1.6 Living Wage Requirements: If the amount of this Agreement is $21,127.46 or more, Provider is
required to comply with Chapter 3.12 of the Ash and Municipal Code by paying a living wage, as defined
in that chapter, to all employees performing Wgrk under this Agreement and to any Subcontractor who
performs 50% or more of the Work under this (Agreement. Provider is also required to post the notice
attached hereto as "Exhibit A" predominantly in areas where it will be seen by all employees.
2. CITY'S OBLIGATIONS
2.1 City shall pay Provider the sum of $8770.00 as provided herein as full compensation for the Work as
specified in the SUPPORTING DOCUMENTS.
2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed
the sum of $8770 without express, written ayproval from the City official whose signature appears
below, or such official's successor in office. Provider expressly acknowledges that no other person has
authority to order or authorize additional Wori which would cause this maximum sum to be exceeded
and that any authorization from the responsible official must be in writing. Provider further
acknowledges that any Work delivered or expenses incurred without authorization as provided herein is
done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement.
3. GENERAL PROVISIONS
3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from
Provider and is free to procure similar types lof goods and services from other providers in its sole
discretion.
3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose.
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3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability
insurance, paid leave, and retirement.
3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject
matter hereof. It supersedes all prior agreements, negotiations, and representations between the parties,
whether written or oral.
Page 2 of 5: Agreement between the City of Ashland and H.D. Fowler Company
3.5 This Agreement may be amended only by written instrument executed with the same formalities as this
Agreement.
3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement:
ORS 27913.220, 27913.230 and 2798.235.
3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws
principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the
Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court,
in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party
expressly waives any and all rights to maintain an action under this Agreement in any other venue, and
expressly consents that, upon motion of the other party, any case may be dismissed or its venue
transferred, as appropriate, so as to effectuate this choice of venue.
3.8 Provider shall defend, save, hold harmless and indemnify the City and its officers, employees and agents
from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of
any nature resulting from, arising out of, or relating to the activities of Provider or its officers,
employees, contractors, or agents under this Agreement.
3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance
caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the
other's officers, employees or agents.
3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable,
such provision shall not affect the other provisions, but such unenforceable provision shall be deemed
modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the
intent of Provider and the City set forth in this Agreement.
3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the
Goods. Provider is responsible and liable for loss or damage until final inspection and acceptance of the
Goods by the City. Provider remains liable for latent defects, fraud, and warranties.
3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require
Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider
does not cure any defects within a reasonable time, the City may reject the Goods and cancel this
Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its
rights under the Uniform Commercial Code, ORS Chapter 72 (UCC).
3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the
manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from
defects in labor, material and manufacture. Provider shall transfer all warranties to the City.
4. SUPPORTING DOCUMENTS
The following documents are, by this referencc, expressly incorporated in this Agreement, and are collectively
referred to in this Agreement as the "SUPPORTING DOCUMENTS:"
• The City's written APRC written proposal dated 9-3-2019.
• The Provider's complete writteii proposal dated 9-16-2019.
Noe 3 ol'5: Agreement between the City of Ashland and H. D. Fowler Compasly
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5. REMEDIES
5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the
remedies available to it under this Agreement and at law or in equity, including, but not limited to:
5. 1.1 Termination of this Agreement; 1
5.1.2 Withholding all monies due for the World that Provider has failed to deliver within any scheduled
completion dates or any Work that have lieen delivered inadequately or defectively;
5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or
injunctive relief; 1
5.1.4 These remedies are cumulative to the extept the remedies are not inconsistent, and City may pursue
any remedy or remedies singly, collectively, successively or in any order whatsoever.
5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or
for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay
immediately any excess to City upon written demand provided.
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6. TERM AND TERMINATION
6.1 Term
This "shall be effective
b true from the date of execution on behalf of the City as set forth below
(the "Effective Date"), and shall continue in full force and effect until November 1 s`, 2019, unless sooner
terminated as provided in Subsection 6.2.
6.2 Termination
6.2.1 The City and Provider may terminate this, Agreement by mutual agreement at any time.
6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement
for any reason deemed appropriate in its sole discretion.
6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior
written notice if the cause is not cured within that fourteen (14) day period after written notice.
Such termination is in addition to and not I in lieu of any other remedy at law or equity.
7. NOTICE
Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in
writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or
by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the
address set forth below:
If to the City:
City of Ashland - Parks and Recreation Department
Attn: Bill Miller; Maintenance Supervisor
20 E. Main Street
Ashland, Oregon 97520
Phone: (541) 488-5340
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With a copy to:
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City of Ashland - Legal Department
20 E. Main Street
Ashland, OR 97520
Phone: (541) 488-5350
If to Provider:
H.D. Fowler
Page 4 of 5: Agreement between the City of Ashland and H.D. Fowier Company
Attn: Joshua Morrison joshmo@hdfowler.com
541-770-4432
8. WAIVER OF BREACH
One or more waivers or failures to object by either party to the other's breach of any provision, term, condition,
or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach, whether
or not of the same nature.
9. PROVIDER'S COMPLIANCE WITH TAX LAWS
9.1 Provider represents and warrants to the City that:
9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply
with:
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS
chapters 316, 317, and 318;
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to
Provider; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of
the foregoing tax laws or provisions.
9.1.2 Provider, for a period of no fewer than six (6) calendar years preceding the Effective Date of this
Agreement, has faithfully complied with:
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS
chapters 316, 317, and 318;
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to
Provider; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of
the foregoing tax laws or provisions.
9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any
political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further,
any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of
this Agreement. Any material breach of this Agreement shall entitle the City to terminate this
Agreement and to seek damages and any other relief available under this Agreement, at law, or in equity.
IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names
by their duly authorized representatives as of the dates set forth below.
Page 5 of 5: Agreement between the City of Ashland and 11.D. Fowler Company
CITY OF ASHL ND: H.D.Fowler (PROVIDER):
i
By: (AIC By: 1-
Signature Signature
Printed Name Printed Name
Titl Title
&lIC) g ac" - 3019
at Date
(W-9 is to be submitted with this signed Agreement)
Purchase Order No.
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Page 6 of 5: Agreement between the City of Ashland and K D. Foit ler Company
. amiad' ,
WATER SYSTEMS FIITOMAT
r u
rygS ~`7~i§ A w.'
r
1
fill
Ilk
flow rates minimum operating water for cleaning filtration degrees
pressure
M100: up to 1,760 gpm I
i
(400 m~/h) less than 1'/.
36 psi (2,S bar) of the total flow i 500-80 micron
MG: up-to 3,522 gpm
(800 m3/h)
features:
Retiable operating mechanism Automatic flushing according to pressure differential
Simple construction and easy maintenance No interruption of downstream flow during flushing
Ideal solution for agricultural filtration requirements High reliability and durability
How the Filtomat Filters Work
General
The Amiad Filtomat M100 Series are mid-range automatic filters, ideal for remote installation sites, with a water-driven self-cleaning
mechanism that doesn't require external power source to operate. With their various screen areas the M100 models support
flow rates of up to 3522 gpm (800 m3/h), with filtration degrees of 500 down to 80 micron and inlet/outlet diameters from F-14".
The Filtering Process
The filtration process begins when raw water flows through the fitter inlet (1) into the new coarse screen (2). Here, the water
is pre-filtered in order to protect the cleaning mechanism from large debris. The water then passes through the inner surface
of the fine screen; dirt particles are trapped and accumulate inside the filter while clean water flows through the filter outlet.
The gradual dirt buildup on the inner screen surface causes a filter cake to develop, with a corresponding increase in the
pressure differential across the screen.
The Self-Cleaning Process
When the pressure differential across the screen reaches a pre-set level of 7 psi (0.5 bar), the M100 filter starts the cleaning
process by opening the internal flush valve. This results in the release of a back-flush stream flowing through the nozzles
out of the hollow suction scanner shaft and the turbine (51, to the drainage pipe (6).
MG Models
Modular configuration, available as a stand alone or as filter bank assembly, with a single control system (AC/DC).
The MG modules are delivered fully assembled, requiring a single connection to the inlet, outlet and drain.
Amiad's Filtomat MG Series consists of the following models:
MG110 (2 x 108LP) for up-to 1,761 gpm (400 m3/h)
MG112 (3 x 108LP) for up-to 2,642 gpm (600 m'/h)
MG114 (4 x 108LP) for up-to 3,522 gpm (800 m3/h)
M100 Models
Amiad's Filtomat M100 Series consists of the following models:
M100-750 for up to 176 gpm (40 m3/h)
M100-1500 for up to 352 gpm (80 m3/h1
M100-4500 for up to 793 gprn (180 m3/11)
M100-6800 for up to 1,760 gpm (400 m3/h)
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ASHLAND PARKS & RECREATION COMMISSION
340 S PIONEER STREET • ASHLAND, OREGON 97520
COMMISSIONERS:
p 5 y ~ Michael A. Black, AICP
Mike Gardiner Director
Joel HellerG
Rick Landt q o, ` 541.488.S340
Jim Lewis AshlandParksandRec.org
parksinfo@ashland.or.us
Julian Bell
September 3, 2019
To whom it may concern,
Please submit a bid for the following;
6" Filtomat #MI06-XLP
200 micron
11OV Electronic control AC
f „ ~ e e t'. -Y
74
q z4
n
Please submit bids to following email;
robbie_fletes@ashland.or.us
Bid No: E375258 Page 1 of 1
H.D. FOWLER
COMPANY
Customer: ASHLAND PARK COMMISSION Estimate: E375258
Estimator: Joshua Morrison Bid Date: 9/16/2019
Job Name: ASHLAND PARKS NORTH MOUNTAIN PUMP STATION
Location: ASHLAND
Line Qty UoM Description Unit Price Extended Price
1 1 EA 6" FILTOMAT # M106-XLP 050007-000164 200 micron 110V AC ELECTRONIC 8,585.00 8,585.00
CONTROL PARTS
2 1 INBOUND FRT / BILLABLE 185.00 185.00
Approximate Total 8,770.00
K ems, 541-884-4129
J.~~® Ir o ~\eoms, Inc. :800-598-6205
4360 Highway 39 - Klamath Falls, OR 97603 - CCB# 155281 Fax: 541-884-0995
QUOTE Email: jwkernsinc@jwkernsinc.com
Date 9/6/2019
Purchaser Ashland Parks - Robbie Fletes Deliver To FOB JW Kerns KF
Salesman Scott Hedrick
Address Ashland, OR How Ship
Project Filter When asap
Phone# 1541-488-5340 Credit
DATE QUAN. DESCRIPTION PRICE EACH TOTAL
EQUIPMENT
1 Amiad M106XLP -200 Micron filter- 12v DC control $ 10,530.04 $ 10,530.04
1 Amiad M106XLP - 200 Micron filter-110vAC control $ 10,530.04 $ 10,530.04
$
$
EQUIPMENT TOTAL (FOB JWK) $ 21,060.08
FREIGHT (estimated) $ 400.00
Notes: $ -
Price valid for 10 days. $ -
$
***Freight is estimated and will be updated upon order placement*** $
$
GRAND TOTAL 21,460.08
This Quotation Subject To The Fallowing Conditions: (a) Errors are subject to correction. (b) All prices are subject to change without notice. (c) Prices FOB point of origin unless
specified otherwise. (d) Quotations
are made for [mediate acceptance unless stated otherwise. (e) All orders are subject to approval by cur credit department. (0 Claims for corrections, reductions or shortage must be
made within 10 days after
receipt of goods. (g) Quote valid for 10 days unless otherwise specified.
Purchaser Signature Date Order # 2109-SSH-044
HYDRO-FLOW, INC. ESTIMATE SHEET
P.O. Box 3849, Central Point, OR 97502 Date: 9/6/2019
Ph: 541.772.4453 Fax: 541.773.3481 Job
CCB No. 110565 Address:
www.hVdro-flow.com Quoted to: Robbie Fletes
robbie.fletes a ashland.or.us
QUANTITY DESCRIPTION UNIT EXTENDED
1 1 6" Amiad M106XLP 200 Mic. with 110V AC controller $ 10,530.00 $ 10,530.00
2 1 Estimated Freight $ 400.00 $ 400.00
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
ESTIMATES GOOD FOR 30 DAYS
EWING, S MEDFORD 4-155 ~ Q U O T A T I O N k PAGE: 1
3600-D S PACIFIC HWY QUOTE DATE: 9/19/2019
MEDFORD, OR IN REPLY TO YOUR INQUIRY PRINT DATE: 9/20/2019
(541) 535-8230 97501 - SUBJECT TO CONDITIONS BELOW - QUOTATION#: 3255701
JOB: DOL-ASHLAND PARKS FILTER
FOR: 74814 CUSTOMER PHONE: (541) 488-5340
ASHLAND PARKS & REC DEPT
340 S PIONEER ST
ASHLAND OR 975202729
CUSTOMER FAX: 1 (541) 488-5314
ITEM LIST NET EXTENDED
DESCRIPTION NUMBER QUANTITY PRICE PRICE PRICE
M106XLP W/ 200 MIC SCREEN 99000000 1 9000.000 9000.00
DC ELECTRONIC KIT FOR M106 99000000 1 600.000 600.00
NET PRICES ARE FOR QUANITITIES AND DESCRIPTIONS
SHOWN HEREIN ONLY, AND NO IMPLICATION OR WARRANTY
IS MADE WITH REGARD TO THEIR CORRECTNESS OR SUBTOTAL 9,600.00
AGREEMENT WITH THE SPECIFICATIONS. SHIPMENT SUBJECT
TO CREDIT CLEARANCE. NO LIABILITY IS ASSUMED FOR NO TAX .00
QUANTITY SHOWN.
FREIGHT 200.00
THE ABOVE QUOTATION IS FOR ESTIMATING PURPOSE ONLY.
WHEN ORDER IS PLACED IT WILL BE SHIPPED AT PRICE
IN EFFECT AT TIME OF SHIPMENT UNLESS OTHERWISE
NOTED ON THIS QUOTATION. QUOTE TOTAL 9,800.00
Taxes on quote are estimated and will be calculated
based on tax rates in effect at time of order.
PRICES SHOWN ARE CURRENT AS OF 9/19/2019 AND WILL
BE GOOD UNTIL 10/19/2019- EXCEPTION: PIPE IS PRICED AT TIME OF SRIPMEW3° ONLY-
BY DAVID LINDERMAN
EWING IRRIGATION PRODUCTS & INDUSTRIAL PLASTICS
AsH~
Purchase Order
o -
v 11 ZS ` ~ -
P~s&RE~REo~ Fiscal Year 2020 Pace 1 of 1
B Ashland Parks Commission r I,r~_ ~~ia;lNr pr~cUrtl.s
I ATTN: Accounts Payable -
L 20 E. Main Purchase 20200214
L Ashland, OR 97520 Order #
T Phone: 541/552-2010
0 Email: payable@ashland.or.us
V S C/O Parks Department
E HD FOWLER COMPANY H `Admin Office
N PO BOX 160 340 South Pioneer
D BELLEVUE, WA 98009-0160 P Ashland, OR 97520
0 T 'Phone: 541/488-5340
R O Fax: 541/488-5314
425 746-8400 Michael Black
10/11/2019 857 FOB ASHLAND 0 R/NET30 Parks Accounts Pa able
6" Filtomat
1 6" FILTOMAT #M106-XLP 1 EACH $8,770.0000 $8,770.00
Per attached Estimate E375258
Project Account: E-000565-999 $8,770.00
GL SUMMARY*************
L 121200 - 704100 $8,770.00
~I
By. ~~.CI M i Date: e/
Authorized Signature - ° a ota1 $8,770.00
cam/ -
CITY OF
ASHLAND
REQ U I S M O N Date of request: 09/19/2019
Vendor Name H.D. Fowler Company
Address, City, State, Zip 12 S Stage Rd Medford Oregon 97501
Contact Name Joshua Morrison
Telephone Number
Email address 541-770-4432
ioshmo o~hdfowler.com
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ AMC 2.50 ed by Council: ❑ Form #13, Written findings and Authorization
❑ Reason for exemption: EDateapproved ion to Bid (Copies on file)
❑ Written uete or re osal attached co of council communication ❑ If couWien quote ncil approval reuired attached
,attachco ofCC
❑ Small Procurement Cooperative Procurement
Less than $5,000 st for Proposal (Copies on file)
❑ Direct Award by Council: : ❑ State of Oregon
❑ VerbalMritten quote(s) or proposal(s) opy of council communication) Contract #
❑ State of Washington
Intermediate Procurement ource Contract#
GOODS & SERVICES ❑ Applicable Form (#5,6, Tor 8) ❑ Othergovemment agency contract
$5,000 to $100.000 ❑ Written,quote or proposal attached Agency
r❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONALSERACES ❑ Special Procurement l In terclovernmentalAgreement
$5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Dale original contract approved by Council:
El (3) Written proposals/written solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Dale - (Attach copy of council communication)
Description of SERVICES
Total Cost
Irrigation Filter for North Mountain Park
6" FILTOMAT # M106-XLP 050007-000164 200 micron 110V AC ELECTRONIC CONTROL PARTS
$ 8,770.00
Item # quantity Unit Description of MATERIALS
Unit Price Total Cost
1 1 EA 6" FILTOMAT # M106-XLP
® 8,585.00 8,585.00
2 1 Ship Freight
185.00 185.00
Per attached quotelproposal TOTAL COST
Project Number o 0 0 5 6 5. 9 e s Account Number ? 2 t 2 0 .'0. 7 0 4 1 0 0 e z 7 0, 0 0 8,770.00
Project Number- _ - _ - Account Number _
ProjectNumber - _ - Account Number _ - $ - - -
'Erpendilure 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:
By signing this requisit'on an thattheCity''spublic ntractingrequirementshave been satisfied. ITDlrector Date Support-Yes/No
Employee: Department Head:/
Department Manager upervlsor: Cit Administrator: (Equal to or greater than $$5,000)
'
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year / NO a*t',k &I I1 1,g
Comments: Depuly Finance Direclor-(Equalloorgrealefthan$5,000) Date !
Form #3 -Requisition