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Home My WebLink About2003-126 PO-Evergreen Safety CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 CITY RECORDER'S COPY DATE O8/23/20O2 Page 1 / 1 03'56i 1 VENDOR: 002071 EVERGREEN JOB & SAFETY 472-100 RICHMOND ROAD SUSANVILLE, CA 96130 SHIP TO: Ashland Electric Department (541) 488-5354 90 N MOUNTAIN ASHLAND, OR 97520 FOB Point: Terms: Net Req. Del. Date: 07/01/2002 Special Inst: Req. No.: Dept.: ELECTRIC Contact: Dick Wanderscheid Confirming? No Quantity Unit .................. Desc. n,'p. ti.on .... U.n!t Price . Ext.'·Price THIS IS A REVISED PURCHASE ORDER BLANKET PURCHASE ORDER Job and Safety Trainin.q 16,200.00 july 1, 2002- June 30, 2003 Julv 1, 2003 - June 30, 2004 .16,848.00 , , Revised po 06/30/2003 Deleted FY05 amount of'$17,521.00 . . · . ,, : , . . , . . I . : , . · , · · · · . · . . · · · .... SUBTOTAL 3.3,048.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 33,048.00 ASHLAND, OR 97520 -' ' AccOunt NUmber ., . AmOunt AccOunt Number Amount:. E 690.11.18.00.606400 25,777.44 . E 691.11.00.00.606400 7,270.56 .... , ,, ,, -- Aut~4z~ Signature VENDOR COPY A request fora Purchase Order T__H/IS REQUEST IS A: [~' Change Order(existing PO # ~¢~ CITY OF SHLAND Required Date of Delivery/Service: Vendor Name: Address: City, State, Zip: Phone: Fax Number Deliver Location Services Only Description Total Cost Solicitation Process: ~ Exempt ~ 3 Written Q~otes (copies attached) "~ Sole Source ~ Invitation to Bid ~ I_ess than ~ Request $5000 Proposal (copies on file) Materials Only Account Number~ ~'~ f/-/'~' ~d.' ~ ~ q~d 0 *Please attach the Original signed contract and Insurance certificate.~ ~_ o Item # Quantity Unit Description Unit Cost Total Cost Account Number___-__- __- _ - *Please attach t~,es. Employee Signature: Supervisor/Dept. Head Signatur .'~~-~----~t~''-''-' NOTE: By signing this requisition form, I certify that the above request meets the City of Ashland Solicitation Process requirements and can be provided when necessary. CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541 ) 488-5300 VENDOR: 002071 EVERGREEN JOB & SAFETY 309 KNOCH AVE SUSANVILLE, CA 96130 FOB Point: Terms: Net Req. Del. Date: 7/1/2002 Special Inst: CITY RECORDER'R Page 1 / 1 03561 SHIP TO: Ashland Electric Department (541 ) 488-5354 90 N MOUNTAIN ASHLAND, OR 97520 Req. No.: Dept.: ELECTRIC Contact: Dick Wanderscheid Confirming? NO Job and of 3 contract of 3 contract 1, 2004 - June 30, 2005 *** This is a change order. *** BILL TO: Account Payable 20 EAST MAIN ST 541-552-2028 ASHLAND, OR 97520 E 690.11.18.00.606400 E 691.11.00.00.606400 Authorized Signature 39 443.82 11 125.18 SUBTOTAL TAX 0.00 FREIGHT 0.00 TOTAL 50,569.00 VENDOR COPY A request for a Purchase Order REQUISITION FORM chaREQUESTIS A: nge Order(existing PO ¢¢~"~ ( CITY OF -ASHLAND Date of Request: ¢:5' "~'--'",¢¢'~z~ Required Date of Delivery/Service: I~::~....../,,/__~ ~) Vendor Name: Address: City, State, Zip: Phone: Fax Number Deliver Location Services Only Description Total Cost Materials Only Solicitation Process: -~ Exempt -~ 3 Written Quotes (copies attached) [--I Sole Source LI Invitation to Bid (copies on file) L_J Less than ~1 Request for $5000 Proposal (copies on file) ,~.~; ccount Number~ ~ //. ~_¢'~ .~ ~, ·. . --~ ._-_-_, .... *Please attach the Original signed contract and Insurance certificate. Item # Quantity Unit Description Un ~ Account Number .... ~ kl ) *Pleaseattachthequotes. Employee Signatu~,e1'~~_ ~____.__.~~..______ %pervisor/Dept. Head Signature: ~ NOTE: By signing this ~equisition form, I certify that the above request meets the City of Ashland Solicitation Process req . when necessary. ~' G:Finance\Procedure~,P~Forms\8_Requisition form.doc Updated on:07/15/02 PENN VALLEY, CA 95946 iNS~E~ EVERGREEN JOB & SAFETY TRAINING DOUGLAS J. LINDSTROM 309 KNOCH AVE. SUSANVlLLE, CA 96130 COVERAGES ACORD., CERTIFICATE OF LIABILITY INSURANCE PROOUCER AS A MATTER OF '"FORMAT O. JAMES A. SEPEDA INSURANCE BROKER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 1621 HOLDER.' THIS CERTIFICATE DOES NOT AMEND, EXTEND OR , ALTER THE COVERAGE AFFORDED BY THE POI.ICIES BELOW. ' INSURERS AFFORDING COVERAGE ....... : NAIC # ~!NS__U__R_E_R_~ _F_!~_S_T FINANCIAL INSURANCE-COMpANYi, INSURER C: ...... i ..... ' INSURER D: - "f ......... INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 545F000309 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON)OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR ~_~ CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABIETY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Eyes, describe under SPECIAL PROVISIONS below OTHER "DESCRiPtiON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPI EVIDENCE OF INSURANCE CERTIFICATE HOLDER CITY OF ASHLAND g0 N. MOUNTAIN ASHLAND, OR 97520 ACORD 25 (2001108) POLICY EFFECTIVE ] POLICY EXPIRATION [ ............................... ................ J LIMITS i JEACH OCCURRENCE j $ 1,000,0--'~'--- AMAGETO-RENTED ...................... : 02/06/2004 02/06/2005 ~~_.o~u~._~) ~._ ~_ ExP (~y one person) __~ _$. 5_z000 j ?ERSO.*--L.-*~VT.];;~V - '; .... 1,000,000 PRODUCTS) COM P/OP A__G~ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ __. PROPERTY DAMAGE (Per accident) $ AUTO ONLY ) EA ACCIDENT $ OTHER THAN __E_A A~c_c_. $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGR EGAT~E ~ $ License # OB31695 jsepeda@gv, net JAMES SEPEDA INSURANCE BROKER Commericel Specialist Jim Sepeda PO Box 1621 Phone 1-800-730-0106 18373 Grey Oak Rd. C.~ Fax 530-432-5035 Penn Valley CA 95946 Si ......................... IN DATE THEREOF, THE ISSUING INSURER WlU. ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAU. IMPOSE NO OBLIGATION OR LIABILITY OF A~D UPON THE INSURER, ITS AGENTS OR \- AUTHOR[ZED REPRESENT C ......,r- ~-,,,~,. ~-' A~C'ORD'i~EJD RPO R/I~TIO N 1988 POLICY NUMBER