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Page 1 / 1
CITY Of
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
~
VENDOR: 000064
EDEN SYSTEMS, INC, TYLER WORKS
POBOX 678076
DALLAS, TX 75267
SHIP TO: Ashland Finance Deartment
(541) 488-5300
20 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net 30 days
Req. Del. Date:
Speclallnst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Cindy Hanks
Confirming? No
Special Assessment Module
License Fees $14,000
Software License and Use AQreement
Amended November 18, 2005
TraininQ $6,000
Expenses $2,200
24,000.00
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520 .
SUEITOTAL
TAX
FIFtEIGHT
TOTAL
~ ~ ~V~S-
Au rlzed Signature
VENDOR COPY
a Order
REQUISITION FORM
CUTY Of
AS 1-1 LAN D
THIS REQUEST IS A:
o Change Order(existing PO #
Date of Request: rl~ifl~i~l
Required Date of DeliveryIServicl~: tl
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
t' A c/r1
\J UI d 1)( d:l:-- DO DO Lo ~
SOLICITATION PROCESS
Small Procurement
o Less than $5,000
o Quotes (Optional)
Intermediate Procurement
o (3) Written Quotes
(Copies attached)
Sole Source
Written findings attached
o Quote or Pro sal attached
Coooerative Procurement
o State of ORNJA contract
o Other government agency contract
o Copy of contract attached
o Contract #
Invitation to Bid
(Copies on file)
Reauest for Propc)sal
(Copies on file)
SDeCla11 Exempt
o Written findings attached
o Quote or Pro sal attached
Emeraency
Written findings attached
Quote or Pro sal attached
Description of SERVICES
L\ lef\~ ~ ~ ;:.
TrlAlvli (\~
o Per attached PR~POSAL
I L{, -ODD ./
/.pJ DDO-
t ~f OJ u:\- mynh J,
t\ t.. '-f(l-L \"\u~ ~ d-oO
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
Project Number _ _ _ _ _ _ . _ _ _
Account Number;}JQ .Q~ - Lc -Q ~ .}t'1l 00
'Items and seNices must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately,
o Per attached QUOTE
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requirements,
and the documentation can be provided upon request.
Employee Signature: cr1J1J ~ tihtJi:, SupervisorlDept. Head Signature: Pl..L.J.;r /L/~ I
G: Finance\ProcedurelAP\Forms\8_Requisition form revised
Updated on: 12/8/2005