HomeMy WebLinkAbout2007-224 Contract - Franell, Michael
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
CONTRACTOR: Michael Franell
CONTACT: Michael Franell
ADDRESS: 916 W. Tenth St., Ste 207, Medford, OR 97501
TELEPHONE: 646-4111
DATE AGREEMENT PREPARED: 08/15/07 FAX: 646-4112
BEGINNING DATE: 08/08/07 COMPLETION DATE: 08/15/07
COMPENSATION: Hourly rate for this engagement will be $175 per hour. Per engagement letter dated
08/15/07.
SERVICES TO BE PROVIDED: leaal services (independent examiner for personnel matter)
ADDITIONAL TERMS: None
FINDINGS:
Pursuant to AMC 2.52.040E and AMC 2.52.060, after reasonable inquiry and evaluation, the undersigned Department
Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have
adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for
utilization of such personal services; (4) the undersigned Contractor has specialized experience, education, training and
capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and
financial constraints provided: (5) the Contractor's proposal will best serve the needs of the City: and (6) the
compensation negotiated herein is fair and reasonable.
NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE
as follows:
1. Findings I Recitations. The findings and recitations set forth above are true and correct and are incorporated herein
by this reference.
2. All Costs by Contractor: Contractor 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.
3. 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 service to which they will be
assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of
Oregon, are so registered, licensed and bonded.
4. Completion Date: Contractor shall start performing the service under this contract by the beginning date indicated
above and complete the service by the completion date indicated above.
5. Compensation: City shall pay Contractor 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.
6. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract.
8. Living Wage Requirements: If the amount of this contract is $16,936 or more, Contractor is required to 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 service work under
this contract. Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where
it will be seen by all employees.
9. 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,
iudaments, or other damaQes, directlv, solei v, and proximatelv caused bv the nenliaence of City.
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 1 of 7
~Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligibie for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obliaation/Liabilitvof Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, cor d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
11. 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. Contractor is a subject employer that will comply with ORS 656.017.
12. Assignment 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.
13. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF
Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if
Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted
against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business
on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or
delegate duties under, the Contract.
14. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Comoensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. Professional Liabilitv insurance with a combined single iimit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each claim, incident or occurrence. This is to
cover damages caused by error, omission or negligent acts related to the professional services to be provided
under this contract.
c. General Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Dama e. It shall include contractualliabilit covera e for the indemnit rovided under this contract.
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 2 of 7
r---'- d. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
I $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
e. Notice of cancellation or chanae. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
f. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashiand, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies
or entities are subject to the City's acceptance. If requested, complete copies of insurance policies; trust
agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
15. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
16. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
17. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
Certification. Contractor sh
CONTRAC OR
BY
n the certification attached hereto as Exhibit A and herein incor orated b reference.
CITY OF ASHLAND:
BY
TITLE
Attorney at Law
DATE
f~f'>f~
ED B :
DATE
August 9 ,2007
CONT
By:
FederallD#
Ljr,9-?J ({oj'!
ACCOUNT #
'Completed W9 form must be submitted with contract
(For City purposes only)
PURCHASE ORDER # t/ ? V"':; ..?-
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 3 of 7
~~IL~IL~~I 1~:31. 5415454112 MICHAEL FRANELL,
RECEIVED ~9!28!2ee7 13:24 5416464112
09/28/2007 FRI 13:31 FAX 541 552 2092 City of Ashland Legal
ATR PAGE 02/03
MICHPEL FRANELL., I\TR
~ 0021003
~
CERTIFICATIONSlRI:'.PR!:'S!:'NTATIONS: Contractor, under penalty of pe~ury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer 10 (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (I) It is exempt from
backup withholding or (ii) it has not been notffied by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends. or (iii) the IRS
has notlfled It that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform tile wO~, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work underthG Contrad shall be performed in
accordance with the highest professional standards, and (d) Contractor Is Qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of. perjury
that its business i6 not in violation of any Oregon tax laws, lmd it is a corporation authorized to act on
behalf of the entity designated above and authorized to do busines:; in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
-X:-
X
-X-
~
~
.
(1) I carry out the labor or services at a location separate from my residence or Is In a
specific portion of my residence, $el aside as the location of the business.
(2) Commercial advertising or business cal'ds or a trade association membership are
purchased for the business.
(3) Telephone Usting is UOO<! for the business separate from the personal residence listing.
(4) Labor or oorvices are performed only pursuant to written contracts.
(5) Labor or servtces are perfullMd for two or more different persons within a period of one
year.
(6) I assume finanCial responslbnlty for defective workmanship or for service not provided
as llvidenced by the ownership of performance bonds, warranties. errors and omission
insurance or liability insLll'ance relating to the labor or services to be provided.
Contnld for Po""'n'" Seovices L... than $25,000, Revloed by Leg.. 03/2612007, ,,_ ~ 01 T
~J/L~fL~~( l~:~l oQlbqbQllL MICHAeL ~~ANeLL,
RECEIVED 69128/2BB7 13:24 5416464112
09i28120~7 FRI 13:31 FAX 541 552 20~2 City of Ashland Legal
AI" I-'AGE El3fEl3
MICH<\EL FR#IELL, ATR
~ 003/003
~W-9 Roquost for Taxpayer GiV9 rotm to the
""'.J"'""lI:aoo~ Identification Number and Certification N<qU8atar. Do nat
~d\f'llln-uy $I!I\cI to lhe IRS.
IJt(l1lifR'ffl!Ul5elVb!
... ~mt; .
. Michael W.:n'andl. At.to~nQV at La.W'
~
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'C_ 916 W. T~nth St.
.~ oty, $t;t8, n lIP code
~ Medford OR 97501
.. lht IlaDUIIt nwnbolrW ~ ~
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I.;t!IIU Taxpayer Identllicalion NUIl1bel' II1NI
Enter"",llN in 1110 'PP'QI"lato box. r", _Ibl>.. _ .....,_.....- tsSNl.
However, for I r.sICMnt. -an., Sole prop1efOr, or ~ entity, tee the ran. I mtNeCIaIs DII
.,. J. Fer Dlher ntt:s. jt is)".Q' ~ ldentlf'atkltl runbAt (E1ft4. r)Ou do not have a rwmtler.
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_It''''ooctiono, matgogQ"""" you paid. ~
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person raquostlng I (ltJe reqoesle!j ana. when lIpllicable. to,
1. Cer!HY that. tht: 1lN ~ am ~Ying ~ COINCt (or you aro
waiting for 8 IIlmber tIl be issue<ll.
2. Cert1fY -)'I>" .'" not 0lJI>Jed. to ba"""" _ding,
or
2. CIaOn "'"""fIlion fmm bad<up witI1lJoI<ing ~ YtlU are a
lJ,S.oxomplPOy<le.
Nole: r. req~ /liVes you .Iorm other IhDn Form W.9
to ~ J'<lIlT lW. you must use t/l@requestet's form If Ills
:wb$I;Orr/i"",_lI1 rti. Form W.,s,
Foragn persarl. If you ere 8 tor. p111'SOn. usa Ute .
apprtllXiO\e Form W-8 tsee Pub. 515. Wilhoold"g of Talc on
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certain types or _.. HClWlMlr. mast tlx _ (:OllI3Ih .
pv.;3on """"" .. . "Mvi1lQ clou..,". Excoptians spociflOd
in !he 3lIving dous. may "",nil an oxomptian from !;Ix to
contlnue for certakt types d Income even alter lI'Ie reclpl..,l
has otherwise beconie a Us, ~ent aneo rot lax p.Jfpooe,.
U you are a u.s. _18I1eO woo is relying on on
exceptlOrl mntafnccl tI tre. saYing daux U 110 tax trest:y to
claim an OllBl1'Cllion from U.S, tax "" C8IUIin typos or "":ome.
yoo IOOSt attach.a statemenllhal specJI1eS the _g five
iterna:
1e The b"e8tJ countJy. ~." lhb must. be (he same
!teary l>1der Wlllch YOO CIa"""" exempIIon /rom .... ., .
nonresident .!kIn.
%. The treal)' al1fCle add<=P.3 the ..<erne.
3. The artlcIe nulTtler (or location) in Ihe bI)c ~ tho/.
COIllOlns tile ~vl'19 clause .nd its oxcopOOns.
... 1"" we end emQIlnt or i",ome tl1IIt ~i1ie$ lor lIE
~emplk>o from tax. .
6. Stificienl facts to justify the OXelnption ((0'" tallJl\da(
the lemu, of the trilBty artide.
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Conlnlol for Po""'",,1 SOM"". L= ~n ~2S.000. Revlood t>y Legal 0312612007, Page 6 or 7
"
, CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
ALL employers described
below must comply with City
of Ashland laws regulating
payment of a living wage.
..11
....,
Employees must be paid a
living wage:
~ For all hours worked under a
service contract between their
employer and the City of
Ashland if the contract
exceeds $16,936 or more.
~ For all hours worked in a
month if the employee spends
50% or more of the
employee's time in that month
working on a project or
3EI!Iper hour effective June 30, 2006
(Increases annually every June 30 by the
Consumer Price Index)
portion of business of their
employer, if the employer has
ten or more employees, and
has received financial
assistance for the project or
business from the City of
Ashland in excess of $16,936.
~ If their employer is the City of
Ashland including the Parks
and Recreation Department.
~ In calculating the living wage,
employers may add the value
of health care, retirement,
401 K and IRS eligible
cafeteria plans (including
childcare) benefits to the
amount of wages received by
the employee,
~ Note: "Employee' does not
include temporary or part-time
employees hired for less than
1040 hours in any twelve-
month period, For more
details on applicability of this
policy, please see Ashland
Municipal Code Section
3.12.020.
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
Contract for Personal Services Less than $25.000. Revised by Legal 03/26/2007. Page 7 of 7
CITY OF
ASHLAND
LEGAL DEPARTMENT
Richard Appicello, Assistant City Attorney
Un Engelhorn. Legal Assistant
Nancy Snow, Legal Secretary
August 15, 2007
Mike Franell
916 W. Tenth St., Ste 207
Medford, OR 97501
RE: Limited Engagement for Legal Services
Dear Mike
On behalf of the City of Ashland Legal Department, I have asked you to provide legal services to the
City of Ashland for the limited purpose of providing independent examination I review of a personnel
action (Grievance, Step 2). This engagement letter sets forth the terms and conditions of your legal
servIces.
The services for seven (7) days begins August 8, 2007 and terminates today, August 15,2007. The rate
for this engagement has been set at $175 per hour.
Please send an itemized statement for this work with the signed copy of the acceptance letter and signed
contract. Should there be any explanation or clarification necessary for any statement, or should the City
have any questions or concerns about the account, the City will contact you immediately. There is no
charge for discussions about the account.
The City may discharge you as its attorney at any time. If the City does so, it agrees to immediately
reimburse you for all costs advanced and fees incurred as of the date of discharge. In addition, the City
agrees to compensate you for your time and expenses incurred after discharge for responding to requests
for information, and to provide copies of any records or materials in connection with your presentation.
Documents in your files prepared in furtherance of your representation of the City will be considered the
City's property. You will retain filed pertaining to the City for a period of ten years, unless those files
are left with the City upon the termination of this Agreement.
You may also withdraw as the City's attorney at any time, so long as in doing so you comply with the
Code of Professional Responsibility for the Oregon State Bar. If you elec to
give the City reasonable written notice of your intention to withdraw.
LEGAL DEPARTMENT
20 East Main Street
Ashland, Oregon 97520
WW'N.ashland.or.us
Tel: 541-488-5350
Fax: 541-552-2092
TTY: 800-735-2900
SEP 07 2007
aooicelr(cj)ashland.or.us
By
snown(Q)ashland.or.us
PPINTEUON'ifeVCi[O'AF,"
Michael Frane]]
August 15,2007
Page 2
If these terms and conditions are agreeable to you and you wish to be retained as counsel for the
City for this limited engagement, please sign a copy of this letter and return it to me. The
original of this letter is for your records.
(f)]elY'
, ~ardA pi
Interim City
Enclosure
RAIle
I wish to be retained as counsel for the City and agree to abide by the terms and conditions of this
engagement letter.
Ale.
DATED this J tr 3ay of August, 2007.
~/,.
f ~'
Page 1/1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE
10/3/2007
PO NUMBER
07852
VENDOR: 007948
FRAN ELL, MICHAEL
916 WEST TENTH STREET
MEDFORD, OR 97501
SHIP TO: City of Ashland
20 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: ADMINISTRATION
Contact: Richard Appicello
Confirming? No
Quantitv Unit Description Unit Price Ext~ Price
Leqal Services 525.00
Independent examiner for personnel
matter, $175 per hour, per enqaqement
letter dated 08/15/2007.
Contract for Personal Services
Beqinninq date: 08/08/2007
Completion date: 08/15/2007
SUBTOTAL 525.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 525.00
ASHLAND, OR 97520
Acdount:NumJ)~r . 1"'<>jecfNumber Am,Dunt Account: Number 'p,r6jfictNutnper AmOl,lnt
E 710.01.03.00.60414 525.00
~ ~ /0/%
Auth cd Signature?
VENDOR COPY
for ,t Purchase Order
REQUISITION FORM
LITY OF
ASHLAND
THIS REQUEST IS A:
D Change Order{existing PO #
Date of Request:
I 9.,:;./7071
I /NMJ/(!L-!
<.(>cW<<lVo
Required Date of Delivery/Service:
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Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement o Sole Source U Invitation to Bid
o Less than $5,000 o Wlitten findings attached (Copies on file)
o Quotes (Not required)
Coooeratiye Procurement o ReQuestfor ProDOsar
o State of OfWIA contract (Copies on file)
Intermediate Procurement o Other govemmeflt agency contract o Special I Exempt
o (3) Wlittefl Ouotes o Copy of contract attached o Wlittefl findings attached
(Copies attached) o EmelOencv
o Contrad # o Wlittefl findings attached
Description of SERVICES
hS5A-<.., .5aU'/~\S //\'/bt/>,yv. AJT c:.x/J/11/IV('/l.
AJ K. )::> U---SO /1./ /V U- /J?,.q 716P--;;J
o Per attached PROPOSAL
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
Project Number ______ - ___
o Per attached QUOTE
Account Number2<'.Q-OL -0.300 ka)ti'l!O
. Items and selVices must be charged to the appropriate account numbers for Ihe financials to reflect Ihe actual expenditures accurately.
By signing this requisftion fonn, I certify that the infonnation provided above meets the City of Ashland AJblic contracting require{lljJnts,
and the documentation can be provided upon request. I) . t7 f
Employee Signature:
SupervisorlDept. Head Signature:
G: Finance\Procedure\AP\Foons\8_Requisition form revised
Updated on: 61812005