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HomeMy WebLinkAbout2006-008 Contract - Integrations LLC Contract for PERSONAL SERVICES Less than $25,000 CITY OF ASHLAND 20 East Main Street Ashland, Oregon 97520 Telephone: 541/488-6002 Fax: 541/488-5311 CONSULTANT: Integrations CONTACT: Elaine Twigg Cornett ADDRESS: 5209 Canyon Dr., Eugene, OR 97405 TELEPHONE: 541-485-7708 FAX: 541-344-0368 DATE AGREEMENT PREPARED: 1/9/06 BEGINNING DATE: Janua 28,2006 COMPLETION DATE: Februar 10,2006 COMPENSATION: $4800.00 for planning and facilitating of Council Goals meeting on January 28th, plus travel expenses estimated at $450, with Cit Providin lod in on Januar 27'h and 28th, Ius $50 for the Personal Stren th Profile SERVICES TO BE PROVIDED: Guidance to Mayor, Council and Department Heads to establish vision, goals and priorities; re aration for Council Goals meetin s; and one 1 Personal Stren th Profile. ADDITIONAL TERMS: Consultant shall rovide services to Cit that are described in the RFP. CITY AND CONSULTANT AGREE: 1. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such service. 2. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel assigned to the work required under this contract are fully qualified to perform the service to which they will be assigned in a skilled and workerlike manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. 3. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 4. Compensation: City shall pay Consultant for service performed, including costs and expenses, the sum specified above. Once work commences, invoices shall be prepared and submitted by the tenth of the month for work completed in the prior month. 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. 5. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 279C.505, 279C.515. 279C.520 and 279C.530 are made part of this contract. 7. Living Wage Requirements: If the amount of this contract is $15,964 or more, Consultant is required to comply with chapter 3.12 of the Ashland Municipal Code hy PilYlng " 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 service work under thir. contract Consultant is also required to post the attached notice predominantly in areas where it will be seen by all employees. 8. Indemnification: Consultant 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 Consultant (including but not limited to, Consultanfs employees, agents, and others designated by Consultant to perform work or services attendant to this contract). Consultant 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: This contract may be terminated by City by giving ten days written notice to Consultant and may be terminated by Consultant should City fail substantially to perform its obligations through no fault of Consultant. 10. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 11. Assignment and Subcontracts: Consultant 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. Consultant shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, ami the approval by City of any assignment or subconiract shali not create any contractuai relation between the assignee or subcontractor and City. CONSULTANT CITY OF ASHLAND: ~~ FIN E DIRECTOR BY BY ! 1Zl4 /OVJ - TITLE Print ~ //ldltJ~ I I DATE DATE CONTENT REVIEW: By: FederallD# 15-/$../ t/ 33h *Completed W9 form must be submitted with contract City Department Head Date: ( tjvJ ACCOUNT # 110. a . ctl. 00 . ~o 101 0. ft,04ICl.)J.ov (For CiifiluJPoses O~~) . I -ll PURCHASE ORDER # V c-:., 5" 'L~ Revised 6-02-05 -j December 24, 2005 Gino Grimaldi City of Ashland 20 E Main Street Ashland, OR 97520 . Integrations "Transforming your vision into dynamic realities. .. Dear Mr. Grimaldi, It is a pleasure to confirm that we will be working with you and the City Council January 28th and February 10th, 2006 to facilitate establishing a vision, goals, and priorities for the City of Ashland. As a recap of what we had articulated in our response to the Request for Proposal and the recent discussions with you and members of the Council: }> We will provide guidance to the Mayor and Councilors to prepare for the meeting on January 28th, and separate guidance to you to pass on to Department Directors and other key staff. }> We will send a Personal Strengths profile to David Chapman and spend a little time with him to bring him up to speed with the rest of you. }> We will guide discussions on: a vision for the City of Ashland that paints a .word picture" of what the City will be -2015; goals with a 2-4 year time-frame that will lead to that vision; and biennial priorities to meet the goals. }> Financials: Our fees and travel time are $4,800; travel expenses estimated at $450 with the City providing lodging January 27th and 28th; and the Personal Strength Profile is $50. It is our policy to bill 50'10 of the fees and all expenses incurred for cancellations within 30 days of our scheduled arrival date. If there is anything else you would like from us, please let us know. We look forward to working with all of you! Sincerely, E~Tw~Corne;tt Elaine Twigg Cornett Principal Partner 5209 Canyon Dr Eugene, OR 97405 Accepted: Title: Date: voice: 541-485-7708 fax: 541-344-0368 .~~~ integrations@integr8.com www.integrB.com January 30, 2006 Gino Grimaldi City of Ashland 20 E Main Street Ashland, OR 97520 ~ Integrations 'Transforming your vision into dynamic realities. " Dear Mr. Grimaldi, It is a pleasure to confirm that we will be returning to work with you and the City Council February 10th, 2006 to facilitate the prioritization of projects and policy work for the FY06/07 for the City of Ashland. As a recap: ~ We will facilitate a work-session of the Mayor, Council, you, and department heads/key staff Friday afternoon, February 10, 2006. The desired outcome is a prioritized list of projects and policies that will constitute the work the Council would like staff to undertake in the upcoming fiscal-year biennium. ~ Financials: Our fees and travel time are $2,400; travel expenses estimated at $250. It is our policy to bill 50'Yo of the fees and all expenses incurred for cancellations within 30 days of our scheduled arrival date. If there is anything else you would like from us, please let us know. We look forward to working with all of you again! Sincerely, Elaine Twigg Cornett Elaine Twigg Cornett Principal Partner 5209 Canyon Dr Eugene, OR 97405 A<<.p~: _~ IJd ~~ (lfl'/6~ , , 7j:t. ~ (,1-7 U~I~~ ~-{?Jn... voice: 541-485-7708 fox: 541-344-0368 integrations@integr8.com www.integr8.com CITY OF ASHLAND Request for Proposal FACILITATOR FOR A ONE-DAY INTERACTIVE "DYNAMICS" SESSION March 15, 2005 The Ashland City Council is seeking qualified individuals to facilitate a one-day interactive "Dynamics" Session. The ideal individual or finn will have significant experience working with City Councils and/or other elected local government officials. The "Dynamics" Session will involve an interactive approach to the issues identified by the Mayor and City Council, rather than a training program for elected officials or boards. . The desired outcome of the "Dynamics" Sessiollis that the Mayor and City Council members will learn more about each other as individuals and identify concrete strategies to bring the individual talents of the group togetherto address the needs of the community. The following topics have tentatively been identified as topics for discussion during the "Dynamics' Session. · Actions that will enhance the effectiveness and teamwork of the Mayor and City Council. · Each individual's perspective of the role of a City Councilor in city government. · The role of Council liaison to city Boards and Commissions and relationship of Council to its Boards and Commissions. . Council operating rules and procedures. · The working relationship between the Council and the City Administrator and staff. . Revising the annual goal setting process. · How to increase the effectiveness of Council's communication with the public. The individual or finn selected to facilitate the "Dynamics" Session will conduct telephone interviews with each of the six (6) Councilors and the Mayor to establish a better understanding of the working dynamics of the Mayor and City Council in preparation of the agenda for the one-day session. An agenda describing the day's schedule of activities shall be prepared by the facilitator, and submitted to the City at least five (5) dayS prior to the one-day "Dynamics' Session. Fran Berteau Administration City of Ashland 20 E. Main Street Ashland, OR 97520 Tel 541-488-6002 Infonnation and Questions oertainina to this Request for PropOsal (RFP) shall be directed to: ~ J.., ~ -~ . ~~--^iL.-~ -\~~ ADMINISTRATION 20 East Main Street Ashland. Oregon 97620 www.ashland.or.us Tel: 541-i~2 Fax: 541-i88-5311 TTY: 800-735-2900 rA' ""tHUD ON RECYCLED PAPER "'T Preliminary Schedule: ACTMTY equest for Proposal Released losing Date and Time (Last day and time to submit roposals to the City of Ashland) DATE Tuesday, March 15,2005 2:00PM, Tuesday, April 12, 2005 Monday, May 16, 2005 Saturday, May ~1, 2005 Note: The actual schedule may vary from the schedule being provided. Individuals or finns interested in conductina the onEHJav "Dvnarnlcs" Session shall provide. at a minimum. the followina infonnation. 1. Due to the varying schedules of the Councilors and the Mayor, and the need for adequate time to prepare for the onEHIay session, the CityWOlild like to propose the onEHlay session take place on Saturday, May 21,2005. If this date is not available, please provide the date(s) you are proposing for the onEHJay session. 2. Describe the qualifications and experience of the individual who will be facilitating the Dynamics Session. 3. Describe the "interactive" approach that will be taken to facilitate the Dynamics Session outlined above. 4. Describe your experience facilitating training sessions for City Councils or other elected local government officials 5. Provide three (3) references. References will be contacted. 6. Provide the fee schedule for facilitating the onEHlay Dynamics Session. Applicable expenses, in addition to the fees, such as travel, lodging, and meals will be reimbursed at cost Currently, the mileage reimbursement rate is $0.405 per mile. ' 7. Please provide any additional infonnation that will assist the City in evaluating your proposal to facilitate the one-day "Dynamics" Session. At this time, the City would also like to consider the qualifications and experience of the potential individuals or finns that may also be interested in facilitating the annual Council Goal Setting Session that is scheduled for January 2006. In the past, the Goal Setting Session has been held over a two-day period with some preparatory and follow-up work to be completed by the ADMINISTRATION 20 East MU1 Street Ashland. 0l8g0n 97520 www.ashland.or.us . Tel: 541~ Fax: 541~11 m: 800-735-2900 " r facilitator. Individuals or finnsthat are also interested in facilitating the two-day Goal Setting Session are encouraged to include the following infonnation with their proposal. Individuals or finns interested in conductina the two-dav Goal Settina Session. shall orovide. at a minimum. the followina infonnation. 1. Describe the qualifications and experience of the individual who would facilitate the Goal Setting Session. 2. Describe the "interactive" approach that will be taken to facilitate the Goal Setting Session. 3. Provide three (3) references. References will be contacted 4. Provide the fee schedule for facilitating the two-day Goal Setting Session. Applicable expenses, in addition to the fees, such as travel, lodging, and meals will be reimbursed at cost. Currently, the mileage reimbursement rate is $0.405 per mile. 5. Provide the date(s) during the month of January 2006 being proposed for the two-day session. 6. Please provide any additional infonnation that will assist the City in evaluating your proposal to facilitate the two-day Goal Setting Session. Evaluation Process: The City Administrator, Gino Grimaldi, will be evaluating the proposals. Proposals will be evaluated for completeness and compliance with the requirements of this RFP. If the proposal is unclear, proposers may be asked to provide clarification; however, no new infonnation or documentation may be submitted. The City Administrator may decide to conduct telephone interviews with the potential facilitators to aid in the evaluation process. The City of Ashland may reject for good cause any or all proposals upon the City's findings that it is in the City's best interest. Prooosal Due Date and Time: Proposals must be received by 2:00pm, Tuesday, April 12, 2005. Proposals received after the due date and time will NOT be considered. Proposals shall be mailed to the location listed below. The proposal being submitted must contain the signature of the individual or an authorized representative of the finn. Proposals must be received at the followina location bY 2:00 p.m. Tuesday. April 12. 2005. Fran Berteau Administration City of Ashland 20 E. Main Street Ashland, OR 97520 Tel 541-488-6002 ., , , *Pfease note that at this time responses may be provided to both portions of the RFP or just the portion requesting a facilitator for the council "dynamics. session planned for May 21, 2005. ADMINISTRATION 20 East Mab SlIeet Ashland. Onlgon 97520 ww.ashland.or.uS Tel: 541~2 Fax:541~11 TTY:~ ~ Integrations .Transfonning your vision and dreams into dynamic realities. " April 5, 2005 Gino Grimaldi City of Ashland 20 E. Main Street Ashland, OR 97520 Dear Gino, We are pleased to respond to the City of Ashland's Request for Proposal to facilitate a -Dynamics" session for you, the Mayor, and City Council. The request specifies an interactive approach (rather than a training program) - since that is the only way we work, we believe that our style of engaging will fit well with the experience you collectively are wanting to create. The most distinguishing characteristic of our work is our focus on relationships and relationship dynamics while achieving tangibl~results - the results identified b.t clients as their desired outcomes, not ones that we decide they sl-,~u:~ have. We are delighted to note that you have labeled the event a -Dynamics" session, since -dynamic" is a word that appears in our mission statement and tagline! The list of topics identified for discussion during the -Dynamics" session comprise an ambitious set of goals for a single day. If the Mayor and Counci I members have a wide diversity of opinion on any of the topics, it could be challenging to complete the whole list in one day. 1. Due to the varyinQ schedules .... the City would like to propose the one-day session take place on Saturday, May 21, 2005 We are available May 21st. 2.Describe the Qualifications and experience of the individual who will be facilitatinQ the Dynamics Session. As it says on our website, -When you hire Integrations you engage with a partnership that models and practices effective and accountable teaming and communication. We work as a team with your team." The partnership is Elaine Twigg Cornett and Zane J Cornett, who have worked together in this arena for eight years and individually for nearly three decades. As Integrations we have worked with well over a thousand people at both the executive and departmental level in teaming, in executive .~ :"'-"coaching, ethics and collaboration workshops, community-based planning, leadership dev~lo'Pfuenl, and facilitation tr~ining. We have experience in both public and private sectors as Integrations and in our professional work prior to forming Integrations. Our experience incl~des most levels of government, ranging from City Boards to regional and national federal assignments. For more complete vitae, please refer to our website at www.inte9r8.com. 3.Describe the "interactiveH approach that will be taken to facilitate the Dynamics Session outlined . Actions that will enhance the effectiveness and teamwork of the Mavor and City Council. Effective teaming requires capitalizing on each m~mber's strengths. To do that, each team member must know the strengths (and challenges) of the!r peers.. Strengths ~ome from both style- based characteristics and experience. We use an instrument called Personal Strengths Profiles (PSPs) with virtually every client with whom we work. We have found the PSPs to be an invaluable tool for assessing and understanding individuals' strengths, developing effective interpersonal communications, and improving team productivity. " 5209 Canyon Dr Eugene, OR 97405 voice: 541-485-7708 fax: 541-344-0368 integrotions@integr8.com www.integr8.com Ashland Dynamics RFP. p2 1, Integrations [PSPs are statistically validated as accurate instruments for the general population, and help people understand where they most naturally excel. The instrument's report provides a description of how people typically communicate with others, make decisions, react under pressure, respond to different environments, and how they are responding to current life-events. It provides a unique insight into a person's personality traits and stress levels.] Our proposal is to use the instrument with yourself, the Mayor, and Councilors; you may also wa~t to consider using the instrument with your department heads at the same time so that everyone has similar understanding of style preferences, strengths, and challenges. The way we use the instrument with groups is fun and engaging as well as informative - it would be easy to include department heads for just that portion of the Dynamics session. The second arena of strengths comes from experience - our proposal is a simple round-robin where each member of the group talks briefly about their background and what their experience provides as an asset to the business of the City Counci I. In this and the pre-session interviews, our approach will be guided by Appreciative Inquiry, in which the focus ,remains on what's working well (rather than what's not working). The premise of Appreciative Inquiry is that if the majority of individual and group energy is focused on doing more of what works, ~he things that don't work tend to drop away. · Each individual's perspective of the role of a City Councilor in city Qovernment. Again, we would approach this with a ~ound-robin, counting on you to speak up if one of the Councilors offers a perspective that steps into the realm of your responsibilities. At the end of the round-robin we would seek consensus from the Council such that they would be in agreement with each other as to their roles as Councilors. · The role of Council liaison to city Boards and Commissions and relationship of Council to its Boards and Commissions. Same as previous topic. . Council operating rules and procedures. We believe that this is a critical component of every groups' effectiveness. Identifying how members will interact and communicate with each other is a values-based norming process; agreeing to those standards invites individual and collective accountability:.--This is the other process we use with virtually every group with whom we work. Our approach is to solicit suggestions from the group and then work from there - we are careful and specific about the choice of words that teams use in their operating rules and procedures, and skilled at drawing out the underlying issues so that those are addressed in the agreed-upon language. . The working relationship between the Council and the City Administrator and staff. Same as for the topic of role of City Councilor in city government. . Revisina the annual Qoal setting process. We wi II assess current views and concerns about ,this topic when we conduct telephone interviews with the Mayor and Councilors, synthesize that information, and initiate discussion with the group when we are all together. Again, we will ask for consensus about approach by the end of the topic. 5209 Canyon Dr Eugene, OR 97405 voice: 541-485-7708 fax: 541-344-0368 integrations@integr8.com www.integr8.com or Ashland Dynamics RFP. p3 ~ Integrations · How to increase the effectiveness of Council's communication with the public. This is the topic which will feel the most like training. We are skilled at communication dynamics, how individuals and groups are likely to respond to information, and have a few simple tools that will assist considerably in effective communications. 4. Describe your experience facilitating traininQ sessions for City Councils or other elected local Qovernment officials We worked with City Council members in Wrangell, Alaska as part of a collaborative community- based planning project we helped the Forest Service initiate. The project included a combination of training and Mdoing" - we did the training aspect during the day and then turned around and applied the learning to Mreallife" in the evenings. Similarly, we have had county and city officials in workshops we've conducted in Utah, Oregon, and Washington. For the City of Eugene our work has been with non- elected employees (see reference section below). Prior to forming Integrations, Zane worked for a local government (Borough) in Alask<\l. A regular part of his responsibilities was to present information, recommendations, and decision items to both the Planning Commission and Borough Assembly. He also worked with,State Legislativ~committees during that time. 5.Providethree (3) references. Lauren Chouinard, HR and risk Services Director, City of Eugene, 541/682-5663 We have worked with Lauren in three different capacities: he asked us to present an interactive ethics workshop for "middle" managers; we worked with his Department in a teaming session; and we presented part of the City of Eugene's new leadership development program. . Mike Bianca and Rich Walsh, Ashland Police Department, 541/552-2138 and 552-2137 We believe you are familiar with the work we've done with APD. We also believe that Mike and Rich are in a unique position to assess how well our approach to engaging with groups will work with the City Council. 1;. b 0 () Gary Lewis, City Councilor, City of Wrangell, 907/874-2914 J:./ b ~ Gary was a part of the community group when we conducted collaboration training with the . ~ Forest Service ond community members in Wrongell. The session was Q combination of training 1 ( ~ - and the k~ck-off of a community-based collaborative plan~~n~ .e~E~s. Pr~viously, Gary had worked With Zane when they were both employees at the Mafanuska-Susltna Borough. 6.Provide the fee schedule for facilitating the one-day Dynamics Session. Applicable expenses, in addition to the fees, such as travellodQing, and meals will be reimbursed at cost. Our fee schedule for all Clients is $2800/day for less than 5 days work $2600/day for 5 or more days. We bill travel time prorated at $800/day. Personal Strengths Profiles are $50 each. It is our custom to use federal per diem rates for the locations in which we work rather than track receipts; if the City of Ashland has a different policy than this, .please let us know. Our fee for phone interviews, synthesis, and review of existing materials will be $2000. 7. Please provide anY"i:1dditional information that will assist the City in evaluating your proposal to facilitate the one-day "Dynamics" Session. One of our greatest strengths is our ability to perceive underlying "currents" and issues, gently and effectively draw them out, and then work with people in a positive and constructive manner. A second strength is that we don't show up "wedded" to an agenda or proc~s - we respond and adjust in "real time" to groups' desired outcomes and behaviors, thereby leading people through productive, effective, and informative sessions. We are committed to success, as defined by our clients. 5209 Canyon br Eugene, OR 97405 voice: 541-485-7708 fax: 541-344-0368 integrations@integr8.com www.integr8.com Ashland Dynamics RFp, p4 ~ Integrations RespOnses for the two-day Goal SettiFlC} Session: 1. Describe the Qualifications and experience of the individual who would facilitate the Goal Setting Session. See details in Dynamics Session response. 2.Describe the "interactive" approach that will be taken to facilitate the Goal Setting Session. It must be noted, of course, that the following response is contingent upon what the Mayor and Council decide at the Dynamics session. Having declared that... We have developed a process for leading groups in which they can articulate their vision in two hours, or less. We've used it successfully with a wide variety of groups at various levels in organizations. From there, it is relatively easy to derive a strategic action plan to guide decisions and programs of work. We frequently begin in small groups and then bring them together to share, compare, and merge their work. In the case of the City Council, the goal would be to articulate their "vision" in the context of what they want to accomplish dyringtheir time in office, with the perspective of,what it will lead to in 3-5 years. Fro", that collective sense of where they would like to guide the City, the goal-setting is a matter of backtracking through milestones to determine what immediate steps are required to achieve the vision. 3.Provide three (3) references. Allen Rowley, Deputy Forest Supervisor, Lewis and Clark National Forest, 406/791-7719 We have worked with Allen in three different capacities: Teaming and strategic vision work on two separate National Forests, and he has taken our facilitation training. Deb Rawhouser, Planning Group Mgr, Washington Office, Bureau of Land Management, 202/452-0354 We guided strategic vision and goal setting work with Deb's group last December and are scheduled to do follow-up work-this May. Maribeth Gustafson, Forest Supervisor, White River National Forest, 970/945-2521 Maribeth has been a client for four years. During that time we have conducted visioning, teaming, and collaborative services, in addition to executive coaching. 4.Provide the fee schedule for facilitatinQ the.two-day,Goal Setting Session. Applicable expenses, in addition to the fees, such as travel, lodging, and meals wjll be reimbursed at cost. See'details in Dynamics Session response. There would be fees for pre-work. 5.Provide the date(s) during the month of January 2006 being proposed for the two-day session. We are currently available for any dates in January with the exception of the 19th. 6.Please provide any additional information that will assist the City in evaluatinQ your proposal to facilitate the two-day Goal Setting Session. See details in Dynamics Session response. Please let us know if there is any additional information that, would be of use to you... we look forward to working with you! Sincerely, 5209 eonyon Dr Eugene, OR 97405 integrations@integr8.com www.integrB.com - T rA' CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 et"~ I )t?L./ t!!...'" r~ Page 1/1 DAtE. 2/3/2006 RGJ\lOMsERi '. "1 06594 . I I VENDOR: 002124 INTEGRATIONS LLC 5209 CANYON DRIVE EUGENE, OR 97405 SHIP TO: City of Ashland (541) 488-6002 20 E MAIN STREET ASHLAND, OR 97520 FOB Point: Terms: Net Req. Del. Date: 1/28/2006 Speciallnst: Req. No.: Dept.: ADMINISTRATION Contact: Gino Grimaldi Confirming? No '.un!t : . l:!.i$cdPtlP'o THIS IS A REVISED PURCHASE ORDER BLANKET PURCHASE ORDER Consultant to facilitate Council Qoal settinQ sessions on January 28th and February 10th. Estimate for 1/28 - $4,800.00, Estimate for 2/10 - $2,400.00 Uri!eRrlce Ext,Prlee ' 7,200.00 PSK Date of aQreement: 01/09/2006 BeQinninQ date: January 28, 2006 Completion date: February 10, 2006 BILL TO: Account Payable 20 EAST MAIN ST 541-552-2028 ASHLAND OR 97520 SUBTOTAL TAX FREIGHT TOTAL 7 200.00 0.00 0.00 7,200.00 , :it~~I)i.( ....... . Project Numl:Jer Amount .(cCol.,"fNum~r , I'I'oJ8Ct.t;lgml:Jer ",/," .., Tl'~ro()unt'~.,~'? E 7 1 0 .01 .02 .00 .6041 Ot 7,200.00 N ~orize::~tre VENDOR COpy 'r THIS REQUEST IS A: o Change Order( existing PO # CITY OF ASHLAND Date of Request: ~ Required Date of Delivery/Service: I I A request for a Purchase Order REQUISITION FORM :l:,,~m.ficttS 5~ G,~ '/)(<... e Yl(... I R en '/os- ~~s--770~ sLfI - 845 - ~g Vendor Name Address City, State,Zip Telephone Number Fax Number Contact Name SOLICITATION PROCESS Small Procurement o Less than $5,000 o Quotes (Optional) Intermediate Procurement o (3) Written Quotes (Copies attached) o Sole Source o Written findings attached o Quote or Pro sal attached Cooperative Procurement o State of OR/WA contract o Other government agency contract o Copy of contract attached o Contract # o Invitation to Bid (Copies on file) Reauest for ProDOsal (Copies on file) o SDecial1 ExemDt o Written findings attached o Quote or Pro sal attached o Emeraencv o Written findings attached o Quote or Pro sal attached Description of SERVICES Work.. se'S>SloN or\.Jall~ d<6 ~ 1/ib. /0 Per attached PROPOSAL Item # Quantity Unit Description of MATERIALS Unit Price Total Cost Project Number _ _ ___ _. ___ Account Number 1 i~ . .DL .tl~ . et2 . jg Qtj 1 (!J . Items and services must be charged to the appropriate account numbers for the financia/s to reflect the actual expenditures accurately. D Per attached QUOTE By signing this requisition form, I certify that the information provided above meets the City of Ashland public c and the documentation can be provided upon request. Employee Slgnature~~ ~. SupervisorlDept. Head Signature: G: FinanceIProcedurelAP\Fonns\8_Requisition form revised Updated on: 1/26/2006 , '1