HomeMy WebLinkAbout2005-304 Agrmt - VP Consulting
Bill To:
City of Ashland, City Hall
20 East Main Street
Ashland, OR 97520
Invoice #: 00006696
Ship To:
City of Ashland, City Hall
20 East Main Street
Ashland, OR 97520
Purchased By: P.O. # SHIP VIA SHIP DATE TERMS DATE Page
Upon Receipt 12/7/2004 1
QTY. DESCRIPTION PRICE TOTAL
1 LaserFiche Integrator's Toolkit $2,500.00 $2,500.00
1 LaserFiche Integrator's Toolkit Annual Software Maintenance, $750.00 $750.00
includes free software upgrades during the year, does not
include software installation. Note* Budget item to be renewed
each year on anniversary date of purchase. ,
SALE $3,250.00
TOTAL $3,250.00
PAID TODAY $0.00
BALANCE $3,250.00
INTEGRATOR'S TOOLKIT CONFIDENTIALITY
AND
SOFIW ARE LICENSE AGREEMENT
This Integrator's Toolkit Confidentiality and Software License Agreement ("License
Agreement") is made between Laserfiche, a California corporation whose principal place of
business is in Long Beach, California ("Laserfiche") and the party (referred to as the
"Licensee") who has lawfully acquired the Integrator's Toolkit.
PLEASE READ THIS LICENSE AGREEMENT CAREFULLY. BY
INSTALLING, COPYING OR USING THE SOFIW ARE OR THE
DOCUMENTATION THAT ACCOMPANIES THIS LICENSE AGREEMENT,
YOU AGREE TO THE TERMS OF THIS LICENSE AGREEMENT. IF YOU DO
NOT AGREE, DO NOT INSTALL, COPY OR USE THE SOFIW ARE OR THE
DOCUMENTATION AND, IF APPLICABLE, RETURN IT TO YOUR SUPPLIER
FOR A FULL REFUND. .
RECITALS
A. Laserfiche has developed certain document imaging and management software
programs which it markets under the trademark Laserfiche@ ("Laserfiche Softwarl~").
Recognizing the desires of some Laserfiche users to interface the Laserfiche Software with
other third party applications or databases, or to add selected external enhancements,
Laserfiche has developed Application Programming Interface ("API") software to assist
programmers to interface Laserfiche Software with other applications and databases, and to
develop add-on modules to work with the Laserfiche Software (collectively "add-on
products"). The API software is used to create programs that send commands to and receive
data from the Laserfiche Software. The term "Integrator's Toolkit" therefore includes the
API software and all documentation, including help files, manuals, instructions, posters and
other schematics, which accompany the Integrator's Toolkit, as well as all updates, upgrades,.
advisories, and other information, whether in electronic or documentary format, related to the
Integrator's Toolkit in any way.
B. The Integrator's Toolkit discloses very valuable trade secrets and confidential
information about the Laserfiche Software to Licensee. The Laserfiche Software and the
Integrator's Toolkit constitute valuable proprietary products and trade secrets of Laserfiche
embodying substantial creative efforts and confidential information, ideas, and eXlPressions.
Laserfiche has invested large amounts of capital and time to develop and promote the
Laserfiche Software. Laserfiche claims copyrights and proprietary trade secrets in the
Laserfiche Software. Consequently, the Integrator's Toolkit is only licensed selecltively to
Licensees whose proposed add-on products or integration projects and intended U8es have
been approved by Laserfiche's management.
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 1
Initials: A2;J~ _
P-cJ
tt:?~8 ~~
{/ ~ edl-A-;$.4J ~ ~
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C. Laserfiche@ is a registered trademark owned by Laserfiche.
D. Licensee understands that the Integrator's Toolkit and the Laserfiche Software are
compatible only with certain types of computers and operating systems and that Licensee is
responsible for assuring the compatibility between its computer systems, its software
solutions, if any, and the Laserfiche Software and Integrator's Toolkit.
II
THEREFORE, in consideration of the premises and covenants contained this License
Agreement, Laserfiche and Licensee agree as follows:
Terms of License Agreement
1. Grant of License. The Laserfiche Integrator's Toolkit contains API
software and Documentation which provide programmatic access to the Laserfiche: Server
and Laserfiche Client. Laserfiche grants Licensee a limited, non-exclusive, non-transferable
license to use the Integrator's Toolkit as follows:
Laserfiche grants to Licensee, subject to the following terms and conditions, a
non-exclusive, non-transferable right to use the Integrator's Toolkit on a single computer,
together with other computers directly connected to and dependent upon the file se:rver, and
the right to use the accompanying written materials, or any written materials that may be
furnished to Licensee after this date (collectively referred to as the "Documentation") for the
limited purpose of producing an integration or add-on product or products for use with a
specific version of the Laserfiche Software. The particular integration or add-on product(s)
and the version of the Laserfiche Software must have received prior specific writt(m
authorization from Laserfiche management. No other add-on product or any other product is
included in this license. Licensee may use the Integrator's Toolkit and Laserfiche Software
which accompanies it for the. purposes approved by Laserfiche management on properly-
licensed successive versions of the approved Laserfiche Software products. All other uses
are prohibited unless and until they are specifically approved by Laserfiche in writing.
Laserfiche reserves all rights not expressly granted to Licensee. This license does not
include the Laserfiche Software other than the particular software which accompanies this
Integrator's Toolkit. The License is subject to the following additional restrictions and
limitations:
* The Integrator's Toolkit contains two separate installations: (1) a standard
installation designed for Licensee, which installs on Licensee's hardware the API
software, together with the Documentation ("the Licensee installation"); and (2) a
separate run-time installation, which installs only the API software but not the
Documentation ("the Run-time installation"). Licensee may redistribute the Run-time
installation with Licensee's approved external integration or add-on product(s).
However, Licensee may only install the Licensee installation on Licensee's own
Integrator's Toolkit Agreement
Commercial Rev. /0.07.05
Page 2
Initials: $:- _
hardware and utilize the API software and Documentation for Licensee's approved
integration or add-on product(s) on Licensee's own hardware; and Licensee shall not
install the Licensee installation on other computers or anywhere else or for any other
purpose.
* "Multiplexing" refers to hardware or software that reduces the number of
computers directly accessing or using a server. The API software may not be used to
create programs that multiplex connections to a Laserfiche Server or any other
Laserfiche Software.
* Licensee may not disclose the results of any benchmark test using the
Integrator's Toolkit to any third party without Laserfiche's prior written approval.
2. Ownershio of Laserfiche Software and Integrator's Toolkit. Laserfiche
shall retain ownership of, and title to, the Laserfiche Software, Integrator's Toolkit and
Documentation (including all adaptations or copies). Copies of the Integrator's Toolkit and
Documentation are provided to' Licensee only to allow Licensee to exercise its rights under
the License Agreement. Licensee is acquiring the license under the terms described in this
License Agreement, and the Licensee acquires no other rights.
3. Cooies and Adaotations. Except as otherwise provided in this License
Agreement, Licensee may not make or authorize the making of copies or adaptations of the
Integrator's Toolkit except as an essential step in the utilization of the Integrator's Toolkit, or
for archival purposes only to back-up use of the Integrator's Toolkit. All proprietary rights
and notices must be faithfully reproduced and included on all copies and adaptations.
Licensee shall not copy the Documentation.
4. Protection of Software. During the continuance of this License
Agreement, and for a minimum period of five years after the termination of this License
Agreement, Licensee shall keep in confidence and shall not disclose to any other person
confidential information and trade secrets of Laserfiche documented in the Integnlltor's
Toolkit. This obligation of confidentiality shall extend beyond five years for such additional
period of time as the confidential information and trade secrets remain proprietary to
'Laserfiche. Licensee shall inform its employees and contractors of this obligation of
confidentiality, which shall apply to all employees and contractors of Licensee eVlen after the
services of such employees and contractors have terminated. Licensee shall take all
reasonable steps to protect the confidentiality of the trade secrets disclosed by Las,erfiche to
Licensee, including, but not limited to, the programming steps required to use the API
software to send commands to and receive data from the Laserfiche Server and Laserfiche
Client. During the term of this License Agreement and for a period of five years lhereafter,
Licensee shall not directly or indirectly, alone or in conjunction with any other person or
company, (a) attempt to write or develop software in order to discover the source code and/or
the trade secrets contained in the source code; or (b) utilize the Integrator's Toolkit,
Laserfiche Software, Documentation, or Laserfiche's trade secrets or confidential
information, either directly or indirectly, to sell, market or distribute any software product
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 3
Initials: ~~ ~
which competes with the Laserfiche Software; or (c) utilize the Integrator's Toolkilt,
Laserfiche Software, Documentation, or Laserfiche's trade secrets or confidential
information, directly or indirectly, to assist, advise or consult with any other person or
company in selling, marketing or distributing any software product which competes with the
Laserfiche Software; or (d) utilize the Integrator's Toolkit, Laserfiche Software,
Documentation, or Laserfiche's trade secrets or confidential information, directly or
indirectly, to convert, or to assist, advise or consult with any other person or complmy to
convert, any end user of the Laserfiche Software to a software product which competes with
the Laserfiche Software. Licensee shall not directly or indirectly attempt to challenge the
validity of the copyrights, trademarks, and trade secrets in the Laserfiche Software and
Integrator's Toolkit claimed by Laserfiche. The software source code and the tradl~ secrets
therein are not licensed to Licensee, and all modifications, additions, or deletions are strictly
prohibited.
5. Other Restrictions on Use. Except as expressly authorized in this License
Agreement, Licensee shall not rent, lease, sublicense, distribute, transfer, copy, reproduce,
display, modify, or timeshare with any other person the Integrator's Toolkit, the Laserfiche
Software or Documentation.
6. Transfer of License. Licensee may not transfer this license to anyone
except with the prior written consent of Laserfiche, which shall not be unreasonably
withheld, and only if the transferee has a bona fide business reason for the transfer and agrees
in writing to be bound by this License Agreement. If Laserfiche approves the transfer of the
license, Licensee shall transfer all copies of the Integrator's Toolkit and the Documentation,
including all copies or adaptations that have been made by Licensee. All other transfers or
assignments of this license shall be void.
7. Indemnification by Licensee.
A. Licensee acknowledges and agrees that Licensee is solely msponsible
and liable for the support, trouble-shooting and maintenance of Licensee' s applic~ltions and
software programs it develops and markets to Laserfiche End Users and others pursuant to its
rights under this License Agreement. Licensee shall assure Laserfiche that any End Users or
others to whom Licensee provides any application to integrate other software or software
applications with Laserfiche Software or to alter or enhance the existing functionality of
Laserfiche Software, themselves are authorized Laserfiche Software licensees. Laserfiche
shall not have any responsibility or liability for any defect, problem or software elTor which
in any way results from or is attributable to any non-Laserfiche software, program, code,
utility or application provided by Licensee or any other provider.
B. Licensee shall indemnify Laserfiche against, and hold it harmless
from, all losses, claims, damages, suits, administrative proceedings, judgments, costs and
expenses, including Laserfiche's attorneys' fees and expert witness expenses (collectively,
"Claims"), resulting from or arising out of Licensee's marketing, distribution, installation or
support of the Laserfiche Software or its use or application of the Integrator's Toolkit,
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 4
Initials: ,$2? _
Documentation or other derivative works or ancillary programs, including Claims based on a
breach of contract, breach of warranty, misrepresentation or concealment, patent, trademark
or copyright infringement, misappropriation or misuse of trade secrets or confidential
proprietary information, or other act or failure to act by Licensee or its End Users. All such
indemnified expenses shall be paid to Laserfiche as they occur on an ongoing basis. If
Laserfiche, in its sole discretion, deems it necessary or appropriate that Licensee assist in the
defense of any such indemnified Claim, Licensee shall do so, and Laserfiche shall pay
Licensee's reasonable expenses for such participation. In such a case, Laserfiche shall have
sole control over the defense of the Claim. Licensee shall have the right to participate in the
. defense of any Claim if it has been named as an additional party or if its rights shall be
prejudiced by non-participation provided that Licensee shall be solely responsible for all of
its attorneys' fees and other expenses incurred due to its defense of the Claim.
C. For purposes of this License Agreement, any act or omission by any of
Licensee's officers, directors, shareholders, partners, contractors, affiliates, employees or
agents, shall be deemed to be the act or omission of Licensee, for which Licensee shall be
fully responsible to Laserfiche.
8. Term. This License Agreement shall commence and terminate as follows:
A. The term of this Agreement shall commence upon your acceptance of this
Agreement and continue until terminated as provided in this Agreement. Either Party may
terminate this Agreement, with or without cause, for any reason or for no good rea.son, on
giving at least 30 days' prior written notice to the other Party. Either Party may terminate
this Agreement for cause immediately following a breach of this Agreement which is not
cured within 15 days following written notice of breach. Either Party may terminate this
Agreement without any prior written notice if (1) the other Party becomes insolvent,
bankrupt, files for reorganization under Chapter 11 or any other provision of the U.S.
Bankruptcy Act or comparable insolvency law applicable where such Party is loc~lted, or is
financially unable to perform its present and future obligations under this Agreement; or (2)
the other Party or any principal, partner, owner, officer, controlling shareholder, director or
managerial or supervisorial employee of the other Party commits or is convicted of a
misdemeanor involving moral turpitude or a felony, or (3) a Party engages in illegal,
unethical, immoral, unfair or unconscionable business practices, competition or conduct
which threaten or would tend to damage the reputation or business prospects of the other
Party; or (4) Licensee violates, infringes or compromises any trademark, copyright, patent or
Trade Secret of Laserfiche, or interferes with any relationship between Laserfiche and any of
its other Licensees or End Users of the Laserfiche Software; or (5) Licensee's license to use
its Laserfiche Software has been terminated.
B. Upon termination of this Agreement, Licensee shall immediately cease all
use of the Integrator's Toolkit and the Documentation and return to Laserfiche all versions
and copies of the Integrator's Toolkit and the Documentation. Licensee shall remove all
such programs and materials from all hard drives and other devices on which the Integrator's
Toolkit and the Documentation may be found.
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 5
Initials: ~(_
C. The termination of this Agreement shall not terminate Licensee's
obligations under this License Agreement, nor shall it release Licensee from the obligation to
pay any monies that it may owe Laserfiche or operate to discharge any liability that Licensee
incurs before termination.
9. WARRANTY DISCLAIMER. TO THE MAXIMUM EXTENT
PERMITTED BY APPLICABLE LAW, LASERFICHE PROVIDES THE INTEGRATOR'S
TOOLKIT TO LICENSEE, INCLUDING ALL SOFfW ARE, COMPONENTS, AND
SUPPORT SERVICES (IF ANY), "AS IS" AND WITH ALL FAULTS. LASERFICHE
EXPRESSLY DISCLAIMS ALL EXPRESS AND IMPLIED WARRANTIES,
INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF
MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. LASERFICHE
DOES NOT WARRANT THAT THE INTEGRATOR'S TOOLKIT WILL SATISFY THE
REQUIREMENTS OF LICENSEE OR ITS CLIENT OR THAT THE INTEGRATOR'S
TOOLKIT IS WITHOUT DEFECT OR ERROR, OR THAT THE INTEGRATOR'S
TOOLKIT WILL OPERATE WITHOUT INTERRUPTION.
10. NO CONSEOUENTIAL DAMAGES. UNDER NO
CIRCUMSTANCES SHALL LASERFICHE OR ITS RESELLERS, AGENTS,
EMPLOYEES, CONSULTANTS, AND SUPPLIERS (COLLECTIVELY,
"REPRESENTATIVES") BE LIABLE TO LICENSEE OR ANY THIRD PARTIES FOR
ANY SPECIAL, INCIDENTAL, CONSEQUENTIAL OR PUNITIVE DAMAGES
(INCLUDING, WITHOUT LIMITATION, LOST PROFITS, LOSSES FROM BUSINESS
INTERRUPTION, LOSS OF BUSINESS INFORMATION OR DATA, COSTS OF
RECREATING LOST DATA, OR THE COST OF SUBSTITUTE EQUIPMENT OR
PROGRAMS SUSTAINED BY LICENSEE OR CLAIMS BY ANY PARTY OTHER
THAN LICENSEE, OR ANY OTHER PECUNIARY LOSS), REGARDLESS OF
WHETHER LASERFICHE OR ITS REPRESENTATIVES HAVE BEEN W ARl'ffiD OF
SUCH DAMAGES OR CLAIMS. NO ACTION MAYBE BROUGHT AGAINST
LASERFICHE OR ITS REPRESENTATIVES UNDER THIS LICENSE AGREEMENT
MORE THAN ONE YEAR AFTER LICENSEE KNEW OR SHOULD HAVE KNOWN OF
THE FACTS WHICH GAVE RISE TO THE CAUSE OF ACTION.
11. DAMAGES. ALL DAMAGES SUFFERED BY LICENSEE FOR
WHICH LASERFICHE IS LIABLE, IF ANY, WHETHER BASED ON A BREACH OF
CONTRACT, BREACH OF WARRANTY, OR CLAIM OF NEGLIGENCE,
MISREPRESENTATION OR OTHER TORT, OR ON ANY OTHER LEGAL OR
EQUITABLE THEORY, SHALL BE LIMITED TO THE ACTUAL AMOUNT LICENSEE
PAID FOR THE INTEGRATOR'S TOOLKIT.
12. Compatibility. The Integrator's Toolkit has been developed for and is
compatible with certain computers and operating systems. Laserfiche does not warrant the
Integrator's Toolkit for any computer and operating system. Licensee shall be responsible
for consulting with Laserfiche for information about compatibility.
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 6
I . . 1 M_';I
mtJ.as:~,:>-_
13. Nonwaiver. No failure to exercise or delay in exercising any right,
power, or privilege under this Agreement on the part of either party shall operate as: a waiver
of any right, power, or privilege hereunder. No single or partial exercise of any right, power,
or privilege under this License Agreement shall preclude further exercise thereof.
14. Severability. If any part of this License Agreement is found or deemed
by a court of competent jurisdiction to be invalid or unenforceable, that part shall be severed
from this License Agreement and shall be deemed to have never been a part of this License
Agreement and shall not affect the validity of the remainder of this License Agreement.
15. Governing Law; Jurisdiction; Venue. This License Agreement shall be
deemed to have been made in, and shall be construed pursuant to the laws of, the State of
California, as if all parties were resident in California and the License Agreement were to be
wholly performed within the State of California. Each party hereby consents to th(~
jurisdiction of the California Superior Court and United States District Court for the Central
District of California. All judicial actions and arbitration proceedings shall be conducted
only in, and each party consents to exclusive venue in, Los Angeles County, California.
16. Entire Agreement. This License Agreement is the complete and exclusive
statement of the mutual understanding of the parties, and supersedes and cancels alll previous
written and oral agreements and communications relating to the subject mater of this License
Agreement. No course of performance, course of dealing, or usage of trade shall override the
written terms of this License Agreement. Notwithstanding the foregoing, a written
agreement, signed by Laserfiche and Licensee and which accompanies Licensee's acquisition
of the Software or the Integrator's Toolkit, shall supersede any terms of this License
Agreement which are inconsistent with the signed, written agreement of the parties.
17. Limitation on Actions. No action or proceeding based on this License
Agreement or arising out of its performance or breach shall be instituted by Licensee more
than one year after the cause of action has accrued. Licensee waives the benefit of any
statute of limitations which specifies a period longer than one year for filing an action.
18. U.S. Government Restricted Rights Notice. All software products
provided to the United States Government pursuant to solicitations issued prior to December
1, 1995, are subject to restrictions as set forth in FAR, 48 CFR 52.227-14 (June 1987) or
FAR, 48 CFR 252.227-7013 (October 1988), as applicable. All software products: provided
to the United States Government pursuant to solicitations issued on or after December 1,
1995 are provided with the commercial rights and restrictions described in this License
Agreement. ContractorlManufacturer is Laserfiche, a division of Compulink Management
Center, Inc., 3545 Long Beach Blvd., Long Beach, California 90807. The Software and
Integrator's Toolkit are subject to United States export jurisdiction. Licensee shaH comply
with all applicable federal and international laws and regulations, including U.S. Export
Administration Regulations, as well as end-user, end-use and destination restrictions issued
by the United States and other governments.
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 7
Initials: ~'- _
19. Captions. The captions used on this License Agreement are for
convenience only and shall not be a part of this License Agreement.
20. Drafting Agreement. Compulink and Licensee are parties of equal
bargaining strength and have had the opportunity to discuss and negotiate this License
Agreement in detail. Compulink and Licensee each waive any provision of law that would
otherwise require this License Agreement to be construed against the party drafting this
License Agreement. Each party shall be deemed to have drafted this License Agre.ement.
Executed on
, 200_, at Long Beach, CA.
COMPULINK MANAGEMENT CENTER, INe.
Signed:
Name & Title:
Address: 3545 Long Beach Blvd
Long Beach, CA 90807
United States of America
Telephone: + 1 (562) 998-1688
Fax: +1 (562) 988-1886
Email: info@laserfiche.com
LICENSEE: t!./ 1'1 tJ~ A..S1IU/,IJD
Signed: ~ ~ .. ~ ;;J-
Name & Title: L~e. ~N~I1~ P,N4'J4LO/~
2-() btsT PI 4/AJ
Address:
4.JJlU4NlJ, () It.
775LP
Telephone: 51./1- 55'2- - ~~J
Fax:
Email: -tul1e.heN.I@t>.s..-/~.of..uS
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 8
Initials: ~l:-_
APPENDIX A
DESCRIPTION OF ADD-ON PRODUCT OR INTEGRA nON PROJECT
AND INTENDED USE OF INTEGRATOR'S TOOLKIT:
6 tVlA, L- I r-..)\E1<..FAe..E TD LA~ERF.c..~
- ~ E..Nl Al L- ~O /'V'-... PO"?3'- I ,fV'.. A?~
- \' f-lR.-S~ o-e-... G\. J...j ~ ~\ '--
~ P~SE ~(~(V\~~
-- SA-v P- lr--J'\O ~ ~E~ \ c... ~
- ~ \..J. ""'\I'..J t\ ~ "SPtV{'.'~ ~ dL"-l ~ E. S
Sf ~ l /I^ P L.~'" r=::: 1--.J-rE- C\)
~ AR-<:..,W, 'J. \ [\J c.n C OJ.NCAA- L1 <s.~
@ Compulink Management Center, Inc. 2004 - 2005
Integrator's Toolkit Agreement
Commercial Rev. 10.07.05
Page 9
Initials: ~-=----
CITY RECORDER'S COpy
Page 1 /1
~.,
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541 ) 488-5300
3/18/2005 1 ~
05844
VENDOR: 003219
VP CONSULTING, INC.
2350 OAKMONT WAY, SUITE 108
EUGENE, OR 97401
SHIP TO: Ashland Computer Servic:es
(541) 488-5339
90 N MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: ELECTRIC
Contact: Dick Wanderscheid
Confirming? No
THIS IS A REVISED PURCHASE ORDER
1.00 Each LaserFiche Integrator's Tool Kit
Annual Software Maintenance
3,250.00
3,250.00
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUlnOTAL
TAX
FREIGHT
TOTAL
E 710.11.05.00.605700
3 250.00
./
VENDOR COPY
A request for a Purchase Order
REQUISITION FORM
C~ITY OF
ASHLAND
Dale of Request: ~~
THIS REQUEST IS A:
o Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name:
Address:
City, State, Zip:
Phone:
Fax Number
Deliver Location
~~S~D~;!,t~ v')r.\!.
~u9-e.,,",1I:! ~r<- Q'7 LlDt
F=G.,c " .s 41- 3l{d - ~~ 7
.Su,'k !O,P
Services Only
Description
L-u-sei'&.,'c..h~ Oeut!loper.>
+00/ k,'-r
Total Cost
Invitation to Bid
(copies on file)
Request for
Proposal (copies on file)
5J, ~.sD
Project Number
p Account Number ~JO-Q 1. ,~~p Ylo...s.. ~
/ .. ~ 1-, *P/ease attach the Original signed contract and Insurance certificate.
(I;t
Materials Only
Item # Quantity Unit
Description
Unit Cost Total Cost
TOTAL COST OF
THE MATERIALS
Project Number
Account Number
- - .
-- -- -- ------
*P/ease attach the quotes.
Employee Signature: -0 tiJ.:... SupervisorlDepl. Head Signature: ~
NOTE: By signing this reqUIsition form, I certify that the above request meets the City of Ashland Solicitation Process req~ ents and can be provided
when necessary.
G:FinanceIProcedureIAPlForms\8_Requisition form.doc
Updated on:07/15102