HomeMy WebLinkAbout2006-069 Contract - Brotherton Pipeline
n.~ !~ ~uu~ !~:~u~n aro~ner~on
.1 O"H tlOO ,~tI"t
p....~
. ~OtHER10
~.~ B~~~~~.~~~~~~T~N
GOIDIDLL, OREGON (541) 856-7075. Fax (541) 855-7284. CCB 106728
PROPOSAL
NAME:
CITY OF ASHLAND
90 N. MOUNTAIN AVE.
ASHLAND, ORE. 97520
ATTN: DAVE TYGERSON
LOCATION: HWY 88 CD LES SCHWAB
~
DATE:
5112/2008
PHONE: 54t-488-5357
FAX: 541-552-2438
CELL:
WE HEREBY SUBMIT ESTIMATE FOR;
BORE UNDER HWY II AND INSTALL 1 -r CONDUIT FOR POWER AND
1 - 2" CONDUIT FOR CABLE TV.
ESllMATE
$1,274
CONDITIONS
BID DOES NOT INCLUDE STATE HWY PERMIT. CITY TO PROVIDE ALL PERMITS AS NEEDED.
AurMRZEOSGtM:=t.~ ~~
NOTE: TID PROPC8AL. MAY BE WITHDRAWN BY us F T A~ .ED WITHIN. DAYS
ACCEPTANCE OF PROPOSAL
The ~ pnc.. ~ and ClClI'lCIIillM.. WI.o.::loor _....., 1ICCefII8d. You a~ authDriZI8d to do the work
- apdied. PAYMENT WILL BE MADE As OUTLINED ABOVE.
A~SH;NA~~~DA1E
s- /a3~
I I
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: $8,274.00, Per proposal dated May 12, 2006
SERVICES TO BE PROVIDED: Bore and install 1-3" conduit for Electric and 1-2" conduit for Cable TV across Ashland Street
(Hwy 66), from Pole #P-4826 to new vault.
ADDITIONAL TERMS:
Contract for WORK less than $25,000
CITY AND Contractor AGREE:
1. All Costs by 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 perform 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.
:~~
~gnature
1Y\\clllV\ ~trtreJ \
Print Name
TITLE <;\A~t\i(\~l\~(\-t
CITY OF ASHLAND:
~ ~~ ~ . ~
FINANCE DIREC ~
b/r?,
CITY ADMINISTRATOR
BY
BY
DATE
DATE
$\~l\\)~
q~~\I~}.~\J
CONTENT REVIEW
CI DEPARTMENT HEAD
if; Ie; /O~
I / I
ACCOUNT # 6 9 tI / / / ~ efl tt? ? t'/ ~ ~ ~-t!J
1f?6~8~
FederallD #
CCB Name ~rorhQ,rtO(\ ~rpOfl.,-tI\)~
CCB#_\Ob~~~
DATE
City of Ashland - Business License # 1L-' ODD GIld-.
PURCHASE ORDER #
. (for City purposes only)
* Insurance Certificates and a completed IRS W-9 form must be submitted with signed contract.
Revised 4-27-05
MAY/31/2006/WED 03:10 PM HART INSURANCE-GP
FAX No. 541 474 1209
P. 002/002
ACORDTII CERTIFICATE OF LIABILITY INSURANCE I DAft (MIMlMYVY)
5/1811006
PRODllCEll nflS CERTIFICATE IS ISSUED AS A MA'rTER OF INFORMATION
"-rt. Insurance AgllDq GP ONLY AND CON~R8 NO RIGHTS UPON THE CERTIFICATE
311 S... r 8~..t, HOLDER. THIS CERnFICAJ:O~ES NOT AMEND, EXTEND OR
Onftt. .a.. OR ..,,2, A1.T!R THE COVERA. AP DI!D BY THE POUCl!S BELOW,
(5U) &7'-5521 (Sll) 17&-1209
INSURERS AFFORDING COVERAGE MAlC I
l/lI\IIIIfO NlURERAi .,.... JU."... IIl~ae CclIIpany
RrDeherton P~ine, Inc., lz:otll.ertClll IiIIUftEft I: 8afeco
COqKlJ;et1011
:L1 801ita ft'ODtage ..,.4 IiIlRlR~ C: .alf corp
Gold Rill OR '7515 lN~!Il D:
I I lilSUR&R E:
COVER OE
THE FrOlICIES OF INSURANCE UmD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POliCY PERIOD INDICATED. NOlWITHSTANDING
N<< REQUIREM~NT. TERM Of\ CONDITION OF ANi CONTRACT OR OTHER DOCUMENT WITH ~ESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUClES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS, EXCLUSIONS AND CONDITIONS OF SUOH
POUCtES. AGGREGATE UMlTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .
nYE. noN
POUCYMlII8IA
GENERAL UADLITY
A X COMM6I\CIAL. G&N&AAl. LlAlIIUTY 0010032 ./1012005
Cl.Altll8MADE[!]OCCVft
$
~ODUtmI . cm.wA:IP AGB s
toe
CONIIlNeD SINllILE UNIT .
. 01CG156,Sfl 611012005 6110/2001 (EllCClClMl)
800LY INJURY .
X (P'er petIOlI)
X JIClOI.y tlJUAy
lPer _4....1 .
:It NON-OWN&O AUTOS
PftOf'MTY OAMME .
lPer accidenl)
lIMA_ LIMILtTV AllrO ONLY. EA IiCOIDfHl'
/MY AUTO ()'I105A THAN EA "IX
AUTOONLV: AGG
UCUlMlIIIIB.LA UAIlLIlY EACH OCOUIVII!NC!
A :It OCCUR o 6..4JMs MAll! 000091., InO/2005 6/10/2006 AGBREGATE
1 000 000
1 000 000
1,000,000
:It 10 tlOO
e WO"ICIM OOM....1lOH /MD 81011<& 101111005 10111200'
IMIlU)Y&JlSI UIlILIn
NfY "1IOrIw:1~AM'NmKlC&Curlll&
ClI'I'IO!MCMIIe" IltCWlleJf
~.......... 0
PAO\/ISIONS
om...
Il.ULIlCWJ ~rft UOO02" "21'1006 10/3812006
D1!SCl'InrnoN Of oPl!RATIDNII LOO,\'YlDNI/VIlICLII/IlllCLUSIOtlS AllDI!D ItT 1NDOftI_1!Ift' IIPICIAL ""OVlllOHI
801M
TlFICATE HOLDER
CANCELLAnON
SHOULD ANT OFTHaA8OVl! ODCIUED POIJCIU lIE CANCELLED IlliFOIlETHE EIlPIMllON
DATIl TNJ:RIOI'. THII.UINlIINIUIUIR WILL INQUYOR TO MAIL ...!L DATIl WRIl'TEN
HOlIOI 1"0 TltIllIlmflCATlI HOL-DIII HAMIUI TO THI . WT ,M.Uft& TO gO eo 'HALL
IIIPOIIE NO OBLlGATIOtI OR 0 UPON THI: INIURER. R'I AGI!HTS OR
IlIIN1: :nvR.
l'untaRIZID RIPR
. ACORD CORPORATION 1881
aU:r of Jt.8blaDd
90 .. IfOlUI,tain AVllmut
ABh1aa4 Ga.'?520
ACORD 26(2OOtlOl)
anll 1 U/.I.UUUI I UU I.I.I,J Aa Ill'U\I 1I'tl;JU1U'I""r.,-\d"
fA! 11 U. :J'l '" UU::!
r. UUI
~~NSURA~C~
www.hartinluruc:e.com
IMPORTANT FAX INFORAfA TIONI
Pi.... deIlYill' at oa~ to:
~ ~ ~PUJ~
FA_:
.~~~ t:J~~
'.
TIUa II p.e--L-of. ~ pap tnuDaill;OD.
Time .ellt:" Date ..t: S /r51l,-,
Pi.... eaIl541-479-5511 iftller. II . probl.. with die fa
e~~
M....e:
C'Lt- n-~~~ ~/Lf>.
'or return fax clW: 541-474-18'0 or 541-474-1209
3389 C4tIec Lalrdi"". . Medford, OR 97504 . (541) 779-42>> . FAX(.S4t) 77.2-3963 "
3215. E. 1St.. P.O. Box 12<<) . Oruao P.. OR. 97528 . (541) 4?9-S521 · FAX (5.nH7....U09
WORK COUP - AUTO - HOME - BUSINESS - UFE -HEALTH - GROUP
IU\ I( I VI LVVUI & UU I I . 1 U Aa IIMl 1I'-1U1U1I'fur.~
'~A nu. J'1 tl' lLU~
r. UU,
II
STATE OF OREGON
CONSTRucnON CONTRACTORS BOARD
SURETY BONO
CCB ## (ifabwdy ~
51078
Slnty~"boad' SS6479C
We. BIODIBRrCJI PIPELmt DC. . '. -r'-9-l
IIId D8BLOPDS SUIft! 8D IRDlM'l!Xn amut.. co.~qualifiechad.......... ~ do ~ iI tbe"';
ofONpa, -11InItJ." Wd"'1aa1y baaad ..... ... StaIi ofQnaaa.. ... _ .. ~ of..... 010&.- ... ~ ...
~....Ad.......ia"_Df DIll TIIOVSAlID DOU.OS 00/100 ..
. . nlOtOOO.OO)
IIwId ....,Gf.. UaitIld S1IIII GfAmaa 10 1&epllid.. ........iDOIS ~ 'JUl. ......,.,......... _1IUIy to.........
.... biad 0InIl.... ... htQw,JIIIICDl~ .1::(..... ........joJady aadlftlDlly..... by..... pal'"
WHBUAS, the ~priDoipal bu __ ~1i0ldiaa far aliC8llle witJa the Cautnotiaa ~ BOIIrd oftbe State of
0...-. or foIo ...... 01 neb c.tifiaat. .. II reqaUod by OIlS Qaaptv '701 to turaiIb . 1Hmd ill tJa. ,..... RID of
S fO t 000.00 . with aaod -. ~.IIlrIly, CClIIditiaaed. u __let fbrth.
. NOW'I'BBlUiPOU." ~ of... ~ obJipti... tIuIt if laid priDajpd witb I8p1d.Io aD WOJt dooo by tJIj J:IJWipaI
.. ""'~'. dcIiMd by au 7OJ.005.11IaU pay Ill........ CbU1U7 be.....,.. ec...-... ('..... -4Ol. Bo.d....
1bo """"'1 by __ of~ .....OJ- wart CII' "'-* ofCGlllbot ill ~.., 01......... iD ~ wiIh OR!
a..,.. 701 ..... 0Alt a.pc.112, .. tit ~ 1haI11&e YUid;.......1o __ Ja fidI tbn:c.......
TIIis bcmd is far 1be oxohlliY. puq)OP of paymeat of ftul orders of 11&8 CouwotioII Ccndnct.als Board. iD ~ with OU
Qapta-70I.
no. bcuul sUll ~ ODe ClCJIltiJndq obliptiou. lad tIae llabU1ty of Ibo I1IRl1 for 12ae ...... of aay aad aD cIUsu which may an.
IlInamlII" .... ill ao evlllt 0lt0elId Ibe ...... of" ,..ItJ ofdais1qd.
11IiI baad I1aU ber:oaIiI c:Iiaatift aa.... dlre1bD ~..... .u~--6 JIr If?-- . I CII'.-.t 11141Wl.....'OIIII,z..m
fa"1IDIiI diIpkted by cw.. plid..... OU a.ap. 701, UDIaJ" AetJ ~ ~ tIa baad. 'l'btI baIId...,.~
by....., IDlI tbc 1alIIl11&e..... of...- MIIIIy for WQIt ............_IIIo""~ ...... ..............1r,r... 30
~ ~ DDdce 10 till piDcipI1l1141M CoaItnati_ Cadt:r8aors Bon ofe. S1Na of o..a- c.o.n.ti~ IllaIlIIOt Iiiait the
PIpCIIIIibiIit) 01" ...., ill- &.1 ca.a. ....110 wart pm fIl_..--a ..... .. ... pIlIiDcl of. CIlIIIrKt ...... jato pdor to ..
~1Nioa.
. lbiI baad -.u utbe ftIid ti ~r- ~ ill IIlCOI'duIce wbh ORS ca..pw701llDlaa filed witb 1be CcIaIIruc:tWl Coaac:aa
Boam wiIhia Iixty (60) cIayt of1lll atelhDwll below. .
~-~
....... .
~of
JULY
.20 04
cs.n
~~~....
A1"lOBDY-D-PACr
Dr.
FIVI CD1'tuPODITBt SUITE 530
4P"9A--
LAD OSWBGO, Oil 97035
<iJo" ..- _... a..
zt,
PLEASE COMPLETE CHECKLIST ON BACK OF:rHIS.FORM
IIA II 101 LUUU/IDU 11. 1 J 1\11 IIMl 1I'O.J1.HI~r.""\4'
Pal 1'0.:)\1 \1\ IlU::l.
r. UUJ
.,/
. /
,
STATE OF OREGON
CONSTRUC'nON CONTRACTORS BOARD
SURETY BOND
CCD'(ihkwiy~ 106728
S,,*, compiIuy'llQId' SS6480C
We, BlDrBD.TOII CORP. . ..~
.ad D,lWISWIElS SUUTr ABD DDBlalIrr cc:lrPAltt .. ClIIp'Ia.tiGa r~ ..............10 do __ ia.. ,..
of 0...... . mIRtJ. .. Wd", fia8ly bcMDlI UIdD" S1* ofOrt&aa fbr 1110 UIe _ bcaIfJa of die SraIa of Cap aa41G1 ....
.........,....iD..._ofl'IPftD DIOUIW1D DIYu.AllROO/1OO - .
. . (S 15..000.00
kwtilllllllt1'of_ "UIiIId.s...ofAmDa III..... U ~. 0lt.S ~101.'' ....,.,...... tnIIy........
WIJ biDd. ouzse.Mt. aar ..... )IaIllIIII...........~ IucceIIClR .. ........iaid7 ... uvaa1lJ. &IDly by ~ pnaeIIJI.
WHBJ.BAS. tile above-Mmccl priDoipIl baa ~ anlicaticm fbr . Ii~ with tU CoannaotiCIG ~ Bod otthe St* of
0teI0D. Dr fM roDowal of pcb Cerdflwe IIld iI Rq1Iirod by ORS Chap..r 701 to fu.naiab . bqd ba tbc pou1 IUID of
S 13 ..000.00 . wi1b pod" taftlc:jaJt aunlJ. caaditiaacd . heroin.. fortb.
NOW 1'BSU.POU, III r-ollditiau of.. fol9iq obliptioD IR tbat if Rid priDcipaI 'With aeprd 10 aU wort daoe by ~ prlDcipal
U . "coatoIctcII" IS 4ofiDod by OKS,701.005. 4aU pay a1ll11DOa1111 GIlt may be ordIlrecl by the Couhc:ticm CoIIIIacltan BOGd apiDM
,. principal by rtaIOJl of........ iqpvpIr warIc or breaQ of COJl1DCt.~ may of_ wart. ill IIOOOldIaca whb. OU
Chapa 701_ OAll CUpt.112, tha.. obliptioD sJaall be wid; ~ to RIIIaia ill full fotce.. effect.
nii boad 11. for the eaclUliYe ,.,.. ofpaJlllollllt of fiDaI orden of1l1. Coutrac:IioD CadndDn Boud ill aoocmI.moo witb OU
Cbapllr 70 I. .
Thla baad abaII be oae eootllMq obUpli-. _ tM liability of dle IIIrlIly for the agrepI8 of aD)' ... all cJaimI which. may ariIe
____ ..... in. ... exceed"lIDIDaIIt of" peu1ty oftil baDd.
11aiIlMmd UalI bocome eG'ed1ve.. .. date tba]llillaipll...... aU~ b ...., ar...u IIId Iha1l ~b- r..m
iD .tr= _tit d.tlpllmd byc1aima pIid __ 013 ar..a- '101, ualca tllllUI'll&J IOCIDl:I' _II" boIlCl. 1bii 1IoDd. may be cace1led .
., dle 1IIlIIl1-......., bit....... olJdalr liability fiIr.WGIk pertoa.ecI OD ... ClGIltIK:fI......... ~~ b7 liviDc 30
~ wna. __ to dII prbu:lfll1Il4 .. c..tnaatioIl Coa1rM:tan laird. of_ sa.. ofOntp. . ~... .wi DGt 1bd ilia. .
~ otfbe IUPly aw... OIdIa nIItiq 10 wcB~ cIuriDs Ii. wadpmocl of a COIdIIGt..... bl10 prior to ..
CIDO'tII~
nu. baDd UaU DOt be~ far~ atliCllmilw iD ~ with ORS a.p.r 70111D1aa fDed with ~ CclaItIucticlD CcIntDalxI
Bc.d widda sbr.1y (60)"" ora. dMe IIlowa Wow.
IN wrl'NBSS WIIBIUiOF, the PIiIadpalIQll Sunt.J
~-:7~ -~
.."... .
~of
JOLY
. 04
.20
HAU 0' &AKA
~"~"ffWI.}tiI:I",..
An'OBBt-IR-JAC!
JIIIr
l'IVE eu-aBtODtB. SUID 530
"..., of.....
LAKE OSWEGO. 01 97035
a".' .., z;,
.PLEASE.COMPLETE CHECKUST ON BACK OFntl8 FORM
~~,
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
CITY RECORDER'S COpy
r 6/5/~ r
Page 1 / 1
-~
06838
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
Conflnning? No
BLANKET PURCHASE ORDER .
Bore and instaIl1-3~ conduit for
Electric and 1-2" conduit for Cable TV
across Ashland Street - from pole
#P-4826 to new vault.
8,274.00
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 MA.IN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
~~~~
Au orlzed Signature
VENDOR COPY
II,
tor (,~
r'">b ~';;;';i ()I viPe,
v1"i~.J1.'-:"~~ w \,.....~"
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
o Change Order(existing PO #
Date of Request: I 05/18/2006' . I
Required Date of Delivery/Service: I I
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
RmthArtnn C'.nq>Andinn
11 Fmnt~A RnM I P 0 Rny 73R
Gold Hill O~nn 97525
541-855-7075
541-855-7284
UII,,,, ~",""""II
n" ProcuI8lll8llt
(3) writter1 Quotes
(Copies attached)
J~e& ~~,c
~v~
o Copy of contract attached
o Contract #
DescrIption of RVI
~~ . 6a ~aJlI' Jo - z..ocG.
~r~ deA'Jl-~ a~~(!~.kL ~
~ ('~ #. ,e'- tfe ~6' ~ ;(.e ~ V!~t:..o?
Per attache& PROPOSAl
Item , Quantity Unit
Description of IlATI!RIAUI
o Per attached QUOTE
Project Number 000060.999
invitation to BId
(Copies on file)
Unit Price
Total Coat
.
Account Number 690.11.18.00.704100
· Items and services must be charged to the appropriate account numbers for the financia/s to reflect the actual expenditures accuretely.
By signing this requisition fo"", I certify that the info""ation provided above meets the City of Ashland public contracting requirements,
n~~rN . ~
EIqIIoyee 819........'-- ._".rr-: "'-~ SupervlsodDopt. Head SIgnIlure: +-
G: FInanoeIProcedul8\AP\Forms\ltRequIsillon fonn I8Vised
UpdaaBcl on: 511812006