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HomeMy WebLinkAbout2006-068 Contract - Brotherton Pipeline Il"~ ..... ,,"''''V .l C i ~UI'"'I'1 arOlOnerlOOn 1~4Ht~~'/~1:f4 p.l . ~O~HER:rO . ~ at1> B~~~!~.~~~~!tQ~~~~N GOLDBIU.,OUGON (541) 855-7075. Fax (541) 855-7284. CCB 106728 . PROPOSAL NAME: CITY OF ASHlAND 90 N. MOUNTAIN AVE. ASHLAND. ORE. 97520 AnN: DAVE iYGERSON LOCATION: OAK KNOLl WOIi DATE: 5/12J2006 PHONE: 541~7 FAX: 541-552-2438 CELL: WE HEREBY SUBMIT ESTIMATE FORi BORE AND INSTAU a- POLY PIPE FOR SERVICES AT THREE LOCATIONS APPROX. . FT EACH E8T1MATEDEACH esTIMATED TOTAL "'.617 $13.851 CONDITIONS BID DOES NOT INCLUDE PERMITS. CITY TO PROVIDE ALL PERMITS AS NEEDED. IF ROCK IS ENCOUNTERED THAT CANNOT BE BORED AN HOURLY RATE WILL BE CHARGED FOR THE REMOVAL OF THE ROCK. AUTHORIZED SIGNA~_J.... .( . Ct ....,~ NOTE: THt$ PROP08AL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN . DAYS ACCEPTANCE OF PROPOSAL The -- pIba. .......~ 8nd ClQ/'-"'." RlllfKtuy8nd.. '--by ~ Yau.. auIharIIIId to do the wart< ........ PAYMENT WILl. BE MADE AS OUTLINED ABOVE. ACCEPTEEUIGNA~ ~TE Sj;~~ . CI T Y OF CONTRACTOR: Brotherton Corporation ASHLAND CONTACT: Michael Cantrell 20 East Main Street ADDRESS: 11 Frontage Road, PO Box 738, Gold Hill, Ashland, Oregon 97520 Oregon 97525 Telephone: (541) 488-6002 FAX: (541) 488-5311 TELEPHONE: (541) 855-7075 DATE AGREEMENT PREPARED: May 23,2006 FAX: (541) 855-7284 BEGINNING DATE: May 23,2006 COMPLETION DATE: June 30, 2006 COMPENSATION: $13,851.00, Per proposal dated May 12, 2006 SERVICES TO BE PROVIDED: Bore and install 3" poly pipe for services at three (3) locations- 735, 765 Oak Knoll and 811 Twin Pines - approximately 80 feet each, ADDITIONAL TERMS: Contract for WORK less than $25,000 CITY AND Contractor AGREE: 1. All Costs bv Contractor: ,Contractor shall, at its own risk and expense, perform the work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor 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 work 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. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall start performing the work under this contract by the date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for work 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. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00 and City shall not be obligated to pay any sum in excess of $25,000.00 unless a separate written contract is entered into by City. . 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Reauirements: ORS 279C.505, 279C.515, 279C.520, and 279C.530 are made part of this contract. 7. Livina Waae Reauirements: If the amount of this contract is $15,964 or more, and Contractor is not paying prevailing wage for the work, Contractor must comply with chapter 3.12 of the Ashland Municipal Code by paying a 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 work under this contract. Contractor must post the attached notice predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor 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 Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract.) Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and approximately caused by the negligence of City. 9. Termination: This contract may be terminated by City by giving ten days written notice to Contractor and may be terminated by Contractor should City fail substantially to perfor.m its obligations through no fault of Contractor. 10. Independent Contractor Status: Contractor is an independent contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. ContraCtor shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract and prior to commencing any work, Contractor shall provide City with adequate proof of workers' compensation coverage. Contractor is a subject employer that will comply with ORS 656.017. 11. Insurance: Contractor shall, at its own expense, at all times during the term of this agreement, maintain in force a comprehensive general liability policy including coverage for contractual liability for obligations assumed under this Contract, blanket contractual liability, products and completed operations, owner's and contractor's protective insurance and comprehensive automobile liability including owned and non-owned automobiles. The liability under each policy shall be a minimum of $500,000 per occurrence (combined single limit for bodily injury and property damage claims) or $500,000 per occurrence for bodily injury and $100,000 per occurrence for property damage. Liability coverage shall be provided on an "occurrence" not "claims" basis. The City of Ashland, its officers, employees and agents shall be named as additional insureds. Contractor shall submit certificates of insurance acceptable to the City with the signed contract prior to the commencement of any work under this agreement. These certificates shall contain provision that coverages afforded under the policies cannot be canceled and restrictive modifications cannot be made until at least 30 days prior written notice has been given to City. Each certificate of insurance shall provide proof of required insurance for the duration of the contract period. 12. Assianment and Subcontracts: Contractor 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. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. CO~TRACTOR: ~_ ~ature l"\~~~\ t::;: lt1\ Print Name TITLE~Vfrl t\-\'t~~ S I~I \\)b FederallD # q '"S~ \\ b'J-l\ l:) CITY OF ASHLAND: ~ ..:h-- ~~ FINANCE DIRECT tj OR /. ~l r;t f? t- --, IYJ-.. CITY ADMINISTRATOR w;j;0~ . BY BY DATE City of Ashland - Business License # t3L - CXJ\)l\ \ d- CONTENT REVIEW ,1..f,~ 91 EPAR ENT HEAD DATE ~/tO/Ob I I ACCOUNT # 6 '11' t' I" I" ~ 6/ ~ ? ~~tf0 PURCHASE ORDER # 6 ~ e.g 7 (for City purposes only) .tl DATE CCB Name t~e.r'~f\ ~(P>~~\~f'\ IDbl d.. ~ CCB# * Insurance Certificates and a completed IRS W-9 form must be submitted with signed contract. Revised 4-27-05 - -' - - - .... - - -.... w . - .., .... .. ,..,"'... . wva. \oil j'nA I'U. .1'1 ,,, ILU,) r. UULI UUL ACORD., CERnFICATE OF UABILITV INSURANCE unllllMlll.nt) 5 II "' na8 CER11FICATE IS D AS A MA'rTER OF INFORMATION ONlY AND CONPeRa NO RIGHr8 lPON W. ClRflllCATI HOLDER. THIS CERTIFICATE DOI8 HOT AII!!!'1. EXTEND OR ALT!R nt! COVI!M. D BY THlrvuCIU aoW. PIIDDUl:8l 1Ia" %DRraaa. AlJeDq CD 321 .... % ~, Inat. .... oa "'S. (5(1) "'-lIl21 (IUJ .,1-120' lIlIUIIIII ~ lIip1liae. IDa.. ~ ClDzpR:.t1_ U 8CNta ftoae.,. .... 41014 till OR '7131 ""'!AI AFFORDING COVERAGI! IlIURERk ..,.... ....... Za_ ......... ..r_ IN8UII&It Q ..If IN8UI"!111t IR&: NAIC . ne POLICIes OFIN8UfWICE L/lJ1'ED BELOW HAVE BEEN I88UED TO THE 1t8JRED NAMED ABOVE FOR1HE POLICY PI!RIOD INDICATED. NOTWIlHSTANDlNG /IN( AEOUIREMEIfT. TERM OR CONDITIOH OF Ntf CON1'RACT OR OTHER DOCUMI!NT WI'I'H IE8PI!CT TO WHICH 1ltI8 csmPICA1'I! MAY BE ISSUED OR MAY PERTAIN, THE IN8lJRMCE AJIIfORDI!!D flY THE POLICE8 DE!BCAeeD HEREIN 18 8UB.IECT TO ALL THE TEAMS. EXCLUSIONS AND CONDIlION8 OF 8UOH POUC118. MGREGATE LIMIT8 8HClWN MAYHAVE BEEN AEDUCED BY PAlO CiI.AIM8. , PCIUGY_ .. 0010012 1I10/Z001 ,/3oO/ZOot 10 000 MeD !XI' ~ PSMOfW.& AfN 1 too 000 8&N&AM.AGGA&IBA18 . :I 000 000 P'I'IOOUaI1I. CDMMlP AGlI I 2 000 001 COMIre) 1IIa.!:.lJMrr . fll0/l0oe && IllllIIMO lIDO 00. IOOI..V MIRY . &rW...-J ='d~ . ....mnv~ . &Par accIdenIt . 01Ca',.ft I/l0/UOll x X Z .. 0000'30., llsoiaoos lJIlCR 1tlAN AUTO Qfil,V: 1W::tt~ fll01200. ~1S 1 000 .00 1 100,000 . "ft, C .....~1IClNMD IWLOVIiIle' UIIIJIY MlI'fIOIIM1'Oi~&CUl'Mi CIIftIla..,.,.1llOl ur-., . ......... cmtM u.JYOAD bO!W.'U" 11O'U 11/3./:1001 11/3./:100' 11100100 1 1100 000 1 ~,...,O.. Me POooa.. a/2./20,. 10/21/200. oe...-.... or ell ~I ~'IIlIIiII/VIIICUI/IIIa UIIlIIC8 AIIIlIlD In' ......ft'/If'I!llM.,.,... 110M CATE HOLDIR CANClLLA1ION 1ItCIUl.D"" OII'YltaMDft IIIK_ ....... lec-"tll'IPIU'OIlITllI!__1lCIII Mft1lflMDl'." __ __ W.L ",VOR1D ..... ..!!.... DAYII1IIlInIN JlO1lCllIlO n.- ..wrI'lCATI HOLIlIIIIWIIlIl TO . . IUr ....10 DO eo etIIlLL ..... NO -..A11CIN CIIl lII'OII TIll! ....... n AIII!N1a OR :rtVIL ~ . ACORD CORPORATION 1. al.tor o~ MIll... 10 .. __~.lD ~_ a.blaol Ga,'7520 ACORD 11__) ____ . __ III MAr/lO/LUUO/lnu 11:1~ AI nRKl l~K~~-ur PA! NO, :>41 r/4 lZU~ r, UUl ~ ~ . II~r'NSURANC~ www.hartinlUtance.com IMPORTANT FAX INFORMA TIONI Please deliver at once to: ~ ~ ,(kPU3~ From: 41~~ t:J ~~ " TIUs is pa~e~of a ~ page tranlmuajoD. Time sellt:' Date sat: S /rv Id:-/. Please call 541""79-5521 if there is a problem. with the fo e~~ Mess.le: ~Ll- rr~-rt>~ ~/'-f>' For return fax dial: 541-474--189001' 541-474-1209 3389 Ctw.ter Lake Hwy. . Medford, OR 97504 . (541) 779-4232 . FAX (541) m-3963 321 S. E. 1St. . P.O. Box 1240 . Grant! P.., OR 97528 ' (541) 479-5521 . FAX (541) 474-1209 WORK COMP - AUTO - HOME - BUSINESS - LIFE - HEALTH - GROUP MAUltlIZUUO/TItU 11: 10 AM WI II"t)lJI(PlLt;-LJ' HI. NO. ~41 4'/4 ILU~ Yo UU4 II STATE OF OREGON CONSTRUCTION CONTRACTORS BOARD SURETY BONO CCB # (if aInlady ~) 51078 Surety company', bODd." 556479C We, BROTHERXON PIPELIlQ:, DlC. . as priDcipaI. aDd DEVELOPERS SURETY jHD INDEMNITY COHP ANY. a c:orporatioll qualified and authorized to do basiDaa ~ the State of Orescm. as .UI1lty. llrO beId aocl firmly bouad QlllO tile s.... of Ongon for the 1IR _ beuc6t of the 9tatrl of~ IDd lIU,Y ok DderutaI)MnODilltbuaaaof DR TBO'DSAlm DOu.ns 00/100 --. ------ . ($10,000.00) JawfUlIDIIIIC)' of1M Uaitai StaIIIS of.Amlrica 10 be paid as JlIOVicied.iII OIlS ~ 701. for wbidl JlIlYDIOId well ad InlIy 10 be made. we biDe! ourselves. our heQs, penaaal ~ JUCCeSSQrI aocl auips. jointly aDd J8Yen1ly. &IDlY by these pas.". WHBRBAS. the abow-named principal baa znade ~pliClltioD for I Jic:easc with the CODItruotiOll CoDtractora Bod of the State of Ore~ OJ for rennra1 of I1lch Cflrtifioatc _d is reqairGd by OltS Chapter 701 to fumish . baud i1l the peaalmm of: S 1 0, 000. 00 . with good anel aafticimlt surety, CODditioaed as 1lereiD lOt fbrth. NOW 'l'ImREFORE, tJ. COAditioas of thB tb.regoiq obliptiou an: tUt if I&ic1 principal with repnl to an woxk dooo by the principal as . ~""~tor" IS dc6Md h1 OB.S 701.005. shaU pay .u amOUldl that may be cwdcnd. by tbe Coasbuctiaa Coatactan Bo.nI..... 1110 priDcipaI by __ ofJleClipDt or iaIpropw work 01' b,ead) of CODtract in periOmDq my of Hid work. ill ~ce with ORS Chapter 70 11ll1d OAll CbapIe:r 812. tbeo this obliplioa shall be void; ~ to remain ill fUll fon:c IIDd eifect. 1'Jris boDd is for the exclusive p\1lPOse of paymflDt of fUlBl orders of the COU1XUetiou CoulJacton Board ill accOl'dauce with ORS Chapter 701. This bOlld ~l be one OODtin'ubl,g obliBatioDo IDd the liability of tho sumy fot the aarcpte of -.ay I.Od an c1ajsu which may arin helrouud. rha11 ill 110 evrlllt e:xceccl the amoUllt oft>> penalty offbis 'bclDd. 'I'bi.s baud s1aU become cfIi:aIiw OIl tile dD 1110 priDcipalUlllelS aU requiRmaIs 1br U-.., OI'maewalllDd sba1l ~ JWIIIIiD ill ettect until ckpleted by c1.u.. paid UDdlr1 OIlS CIIptw 701. UDJas tbe surety IOCJOIlJ C8DCeIs ths baDd. 'I'hia boDd may 'be CIIllUUod by b $IJI8ly tad the I1Ilflly be Je1iwecl affmther PbWay for work pcrtbDDecl OIl tbD c:aaIDc!I ea&eIed aftao ......=J1a1iVII 'by aMa8 30 eta,.' writIIla notice to tb& priDcipa1 and the CoustructiDQ COI1fZIICIOtS B08rd of the Slat. of Ole... C...natiOJlsuU DOt liiuit the reIpODSihility ottbe suretyb fiaal ordas 181__ lO work pafODDDCl dIviaz. the wom ~ of a COQtrKt eatlncl jQto pOor ~ the caceUa1ioa. This bcmd sb.alluot be ftlicl b pmpctaeI oflic:ainl in IICCOniIDce wi1h ORS Chapter 701 UDless filed with 1he CoIlstnIct1an Cowacton Board withiD sixty (60) days of tho date sboWll below. :W~ad~ Surety~: .".:; ,.,.;; . ~ - day of J1JI.Y .20 04 (Sa]) e~f-t",.. A'l'TOBDY-D~FACT 7JfI. un CERTEIlPODlTB, SUITE 530 4p1Ic)l Add,,,, LAKE OSWEGO, OR. 97035 (SIll' 00- _00' k. z~ PLEASE COMPLETE CHECKUST ON BACK OFTHIS.FORM MAY/ltl/LUUb/'l'IiU II: I~ AM HAiH IN::)lJ~Pl'(;t:-l,;P HI No. ~41 4'14 ILU~ r. UUj ~ . / I STATE OF OREGON CONSTRucnON CONTRACTORS BOARD SURETY BOND CCB # (ifalteady ~ucd) 106728 Surery company's bQnd" 556480C We, BllOmERTOIII CORP. . .. prjac~ IIId D!vKLOPEllS SlJUTY AND IRDIHHITY COMPANY. a corporation qualified IDchucborized 10 do busiDess.the State of 0Jep. u 1UI'CtJ. .. held IID\i ~~ UDto the Stats of Oroaoa. fur tho use lDd beae8t ofdla Srata of 0I8gc0 aucl8O,)' other inunsted penoa ill tbG sum of P rBOUSABD DOI..J..AllS 00/100 -- -------- -- . (S 15,000.00 1awfb1 ~ of the l.JaitBd S1aIIlI of.Aaurica to be paid as pIOYidId in ORS Qapter 701, b wbic:h pBJIDGltweD ad bWy to be made, webiDd owseJvea. our heirs. pIlDOQIl npraaaIatives, suc:cesson au.d usigu. joill1ly qd sevaally. finDly by ~ plOSezIJS. WHB'.lW.AS, the above-lWDcd principii. bas made .pplication for I lioasc with the ConstruClion Conlr8CtOl'8 Board of the State of Oreloll, or for rODowal of I\\ch Cenlficate ad is required by ORS Chapter 701 to tumisb a bOJld in the penal 5~m of S 15,000.00 . widI good aDd pfftcjent surcl)t. conditioned III herein set fOl1b. NOW TBEllBFORE, the CODditiODl of tIao f'oreaoins oblitation arc that if said priDcipal with regard 10 all work done by tbe principal .1 a "connctar" IS dofiaod by ORS.701.oo5, shall pay all am01mtll1hat may be ordered. by the Coo,struction Contracton Board apiDSt the principal by reascm of DIlsliseDt OX impJvpllr work or breach of COIlnct ill perfoImiIIg lID)' of Hid work, in aCC01'daDce with ORS Chapb::r 701* OAR. CUp_SI2, tbom tbiI obliption shall be "Void; oIhawiss to n:maia in full force and effect. TIai$ bODd is for the exclu&ive purpose ofpa)'Dl8Dt offiDtl orden of the COllstzuctioa Contractors Board in.~ with OIlS Cbaptlr 701. 'Ibis bond shall be ODe contilluiDg obllSltioa. and the liability of the surety for the agreptll of any and .U claims which may anae bcreundw sb11 inno eveat exceed the aDI01lDt oftbe peulty oftbil bad 1'hiJ bcmd shall become effective QD the date the ~ meets all requiremeDtI {O". 'liceDsiug or nmcwal mcl sball oantinuously rezn.m in ctr= until depl$d by c1aimI paid UDdar ORB Chapter 701, unless the I1lnlty SOODCr ClDCCIs eIle bond. Thill bond may be c:acel1ed . by tile IUt8t1 mJd. tJ. nn:ty be reJiftecJ of tbdber liability for wodc p<<fonaecl on cbe CClGtrKfs eablI:Ild __ ~Uat"' by pvmc 30 ~ writbm DOti.ce co the prblcipa1 d lie COJIItnIctioD COD1IW:ton &oll'd of the Stabt of Oleson. CuClllJ.a1iOll shall DOt limit.... . lUpDDIibility of the IUfIIty tbr fiDal oJdea n1atiq 10 wed pedongcd during the work pmod. of . COIltr8Ct eatered into prior to the QDcel1ation. . . .. Tb.ilI band _II not be valid fOJ: putpOllll oflicrmiq in acc:otdaoce with ORS CbaphIr 70111D1ess filed wi~ the ConatNction ConIraCfOr$ Boed widUn sixty (60) 4&71 oftlm datlt shown. below. IN wrrNESS WHEREOF, the PrlDc:;palaa4 Sunty have hadu set theirhands~and..... thiI 9TH _br ../ /"".:: ~ PJ (Seal) $lgNtlIra MARK 0' BARA If-. Iff AIttIfwy in JtII:I ",... day of JUl,y ,10 04 ATTOBKEY-IN-]!,ACT 211M FIVE CDTERPOIlfrB, SUITE 530 .4pnq ,c.... LAKE OSWEGO. OR 97035 01)' ~ z;, .PLEASE.COMPLETE CHECKUST ON BACK OFnilS FORM r~' C I T Y 0 F CITY RECORDER'S COpy A~~ ~~~ D r 6/5/2006~ ASHLAND, OR 97520 (541) 488-5300 Page 1 / 1 06837 VENDOR: 008118 BROTHERTON PIPELINE CORPORATIO 11 S FRONTAGE ROAD PO BOX 738 GOLD HILL, OR 97525 FOB Point: Tenns: Net Req. Del. Date: 5/23/2006 Speclallnst: SHIP TO: Ashland Electric Department (541) 488-5354 90 N MOUNTAIN ASHLAND, OR 97520 Req; No.: Depl: ELECTRIC Contact: Scott Johnson Confinning? No BLANKET PURCHASE ORDER Bore and install 3" poly pipe for services at three (3) locations - 735, 765 Oak Knoll, and 811 Twin Pines - approximately 80 feet each. 13,851.00 Contract for Work Date of aQreement: OS/23/2006 BeQinninQ date: OS/23/2006 Completion date: 06/30/2006 Insurance required/On File BILL TO: Account Payable 20 EAST MAIN ST 541-552-2028 _ ASHLAND, OR 97520 SUBTOTAL TAX FREIGHT TOTAL 1 ~ ....J.. - - ./'~ - AlifiQHzed Signature VENDOR COPY !i: t.~' f"'l ;;, v 1.; ,,".-' CITY OF ASHLAND REQUISITION FORM THIS REQUEST IS A: o Change Order(existing PO # Date of Request: I 05/18/2006 Required Date of Delivery/Service: I 'i Vendor Name Address City, State, Zip Telephone Number Fax Number Contact Name RmthArtnn l".nr;p:u':ation 11 Fmnt9 Rtwt I P 0 Any 73R Gold Hill ~on 97525 541-855-7075 541~5-7284 u;a,,, ~....""'II SOLI ITATION PR ~I ProcuI"8llllllt Less than $5.000 Quotes (Optional) State ci ORlWA contract Other government agency contract o Copy of contract attached o Contract # (3) Written Quotes (Copies attached) ~ ~..A.A<...~ @t.1t 'A~1t:- /A.> (.1.4Lt.E; Description of _RVI ~'6m:rO b; .::sz,Ul& J~- ao()~ C;::;~,", 7-" A!.-__cl"$ -;7 ~ $" 7 ~ S-- ,e)~ (d (eA" Per attached PROPOSAL ~, ~ (" I 'T7 U-l ~.'~ t.--~ !?.-/ It.... " Quantity Unit Description of IlATI!RIAUI Unit Prtce Total Cost Project Number 000054.999 Account Number 690.11.18.00.704100 · Items and services must be charged to the appropriate account numbers for thefinancials to reflect the actual expenditures accurately. ~;1(/1;- ~ }" 1 l ;-~">r, ur ~~ )4] ~ , (" , " '" t~:i,~ t~~~'ii;':A' 11;J<!{rlf;J::-:j. flli~ ~i~~~~"ffr1il'~~::i i;~' ~~J 5:J1 ~1'~l"j' 1it\~~ '" ii'$<-oE:e~. .or.; J ;~, ~ ~r,\i,'~~"". ',\[, "i\L'~J':jn ",: ~~:j\.~....~~"'~\~ :r~if;' '",~ ~~ltj~~~,~~~ ~~~" ~, 1r.;:'~<;;: iI ..~. 'Y"q"',:"":~,,~~' ,>".." J0 ,t;~::~.),~~ (dt,t~:f h.if ~/ -'1t:",~g., o Per attached QUOTE By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting l8qt,Jit8ments, and the documentation can bejJrovided. upon ffl9uest. Employee Slgnatu~.:z:;L' ("~~ ~,~ ~ ',,-,. Supervlsor1Dept. Head Signature: G: FInanoe\Procedul8'APV=onns'U~equislllon form revised UpdaEd on: 511812006