HomeMy WebLinkAbout2008-165 Contract - Harrang, Long, Gary, Rudnick, Attys
CONSOLIDATED CONTRACT FOR PERSONAL SERVICES
FY 2008-2009
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541-488-6002
Fax: 541-488-5311
CONSULTANT:
Jens Schmidt
CONTACT:
ADDRESS:
Harrang Long Gary Rudnick P.C.
360 E. 10th Ave, Suite 300
P.O. Box 11620
Eugene, OR 97440-3820
TELEPHONE: (541) 485-0220
DATE AGREEMENT PREPARED: FAX: (541) 686-6564
BEGINNING DATE: 07/01/2008 COMPLETION DATE: 06/30/09
NORMAL COMPENSATION: $275.00 per hour for Mark Amberg; $275.00 per hour for Kathryn Brotherton; $345.00
per hour for Jill Bruce; $280.00 per hour for Emily Jerome; $345.00 per hour for Jeffery Matthews; $345.00 per hour for
Jens Schmidt; $210.00 per hour for Lauren Sommers; $225.00 per hour for Ross Williamson; $115.00 per hour for
paralegals Alison Farver and Debora Halbert. Rates for attorneys or paralegals within the firm will be reduced by
10% for legal services. Travel rates will be reduced by 50% of the normal rate.
SERVICES TO BE PROVIDED: See Exhibit C
ADDITIONAL TERMS: Not to exceed $65,000.00
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. This Contract is exempt from formal competitive selection
procedures pursuant to AMC.2.52.050.E.
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
C~. \
'\""
Contract for Personal Services Approved for FY 2008-2009/ Revised by Legal 07/0112008, Page 1 of 6
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 $18,088 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,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
10. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Citv'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 eligible 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/Liabilitv of 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, c or 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
Contract for Personal Services Approved for FY 2008-2009/ Revised by Legal 07/0112008, Page 2 of 6
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 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 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
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
d. Automobile Liabilitv insurance with a combined single limit, or the equivalent. of not less than Enter one:
$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. AdditionallnsuredlCertificates of Insurance. Contractor shall name The City of Ashland, 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. Nona ro riations Clause. Funds Available and Authorized: Ci has sufficient funds currentl available and
Contract for Personal Services Approved for FY 2008-2009/ Revised by Legal 07/01/2008. Page 3 of 6
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
CONSUL T
Signature
William F Gar
Print Name
t e certification attached hereto as Exhibit A and herein incor orated by reference.
CITY OF ASHLAND:
dPj,.:L ~
FINANC IRECTOR
~ \ ~ I OCb ~ BY
BY
TITLE
President
Lee Tuneberg
~2-I~ g/
I /
CONTRACT AWARD AN If FiNDING E
By: Richard Appicello / .
DATE
93-0844033
City Department Head
710-01-03-00-604140
~, ~'OtO~
DATE
FederallD#
ACCOUNT #
*Completed W9 form must be submitted with contract
(For City purposes only)
PURCHASE ORDER # 4J &7 ~g G
tt5 ~ ~
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Contract for Personal Services Approved for FY 2008-2009/ Revised by Legal 07/0112008, Page 4 of 6
EXHIBIT A
CERTIFICATIONSIREPRESENTATIONS: Contractor, under penalty of perjury,
certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID
(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 notified 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 (in) the IRS has
notified 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 the work, (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
under the Contract 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 is
not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an
independent Contractor as defined in the contract documents, and has checked four or
more of the fo lowing criteria:
(1) I carry out the labor or services at a location separate from my residence
or is in a specific portion of my residence, set aside as the location ~f the
/<-'business.
./ (2) Commercial advertising or business cards or a trade association
/'membership are purchased for the business.
/' (3) Telephone listing is used for the business separate from the personal
residence listing.
~(4) Labor or services are performed only pursuant to written contracts.
L-- (5) Labor or services are performed for two or more different persons within a
period of one year.
Contract for Personal Services Approved for FY 2008-2009/ Revised by Legal 07/0112008, Page 50f6
~
I assume financial responsibility for defective workmanship or for service
not provided as evidenced by the ownership of performance bonds,
warranties, errors and omission insurance or liability insurance relating to the
labor or services to be provided.
~o -og
Contractor
(Date)
Contract for Personal Services Approved for FY 2008-2009/ Revised by Legal 0710112008, Page 6 of 6
ACORq CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
08/20/2008
PRODUCER (541)484-6624 FAX (541)686-2726 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Pacific Benefit Consultants, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
450 Country Club Road #330 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Eugene, OR 97404
INSURERS AFFORDING COVERAGE NAIC#
INSURED Harrang Long Gary Rudnick PC INSURER A: American Economy Insurance 19690
360 E 10th Ave Suite 300 INSURER B;
PO Box 11620 INSURER C:
Eugene, OR 97440 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
,Irf: ~~~ TYPE OF INSURANCE POUCY NUMBER pg.~Y EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 02CE1928521 04/14/2008 04/14/2009 EACH OCCURRENCE $ 1,000,OO(J
t-- DAMAGE TO RENTED 200,00(J
COMMERCIAl GENERAL LIABILITY S
- o CLAIMS MADE [!] OCCUR
MED EXP (Anyone person) $ 10,000
A - Excluded
PERSONAL & ADV INJURY S
- 2,000,000
GENERAL AGGREGATE $
'-- 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
rxl POLICY n ~f8r n LOC
AUTOMOBILE LIABILITY 02CE1928521 04/14/2008 04/14/2009 COMBINED SINGLE LIMIT
r-- (Ea accident) S 1,000,000
ANY AUTO
r--
ALL OWNED AUTOS BODILY INJURY
i-- (Per person) $
SCHEDULED AUTOS
A X
HIRED AUTOS BODILY INJURY
X $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
S
~ DEDUCTIBLE $
RETENTION S S
WORKERS COMPENSATION AND I T~~~I~J'~R I 10J~
EMPLOYERS' LIABILITY
ANYPROPR~T~ARTNE~XECUT~E E.L. EACH ACCIDENT S
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
I Except 10 days notice of cancellation for non payment of premium
C
City of Ashland
Attn: Lee Tuneberg
20 East Main Street
Ashland, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
EXPIRAnON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NonCE TO T':fE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
cY~ f)~
Pat koreen PK
ACORD 26 (2001/08)
@ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pOlicies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
o
Form W.,9
'=
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
Check appropriate box: 0 IndividuaVSole proprietor lXI Corporation 0 Partnership
o Umlted Iiablrlty company. Enter the tax classification (D=eflSl"8Qarded entity, C=eorporation, P--PSrtnershlp) ~ _ _ _ _ _ __
o Other (see Instructions) ~
Address (number, street, and apt. or:. suite no.)
360 E. 10th Avenue, Suite 300,
City, state, and ZIP code
Eugene, OR 97401
Ust account number(s) here (optional)
(Rev. October 2007)
Department of the Treasury
InternaJ Revenue Service
Name (as shown on your Income tax return)
Harrang Long Gary Rudnick
Business name, If different from above
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o Exempt
payee
Requester's name and address (optlona~
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid
'backup withholding. For incflViduals, this is your social security number (SSN). However, for a.resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Note.. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter. .
Certification
I~!!
or
Employer identification number
93 :0844033
aver Identification Number
Under penalties of pe~ury, I certify that:
1. The number shown on this fonn is my correct taxpayer identification number (or I am waiting for a number to be. issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Intemal
Revenue Service ORS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I .am no longer subject to backup withholcling, and .
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement
arrangement ORA), and generally, payments other than interest and cflVidends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign I Signature of 0., _ .. t)
Here U.s.'person ~ ~ .f ~
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Date ~
,II/O?
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
. An individual who is a U.S. citizen or U.S. resident alien,
. A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
. An estate (other than a foreign estate), or
. A domestic trust (as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Fonn W-9
has not been received, a partnership is requi~d to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
. The U.S. owner of a disregaroed entity and not the entity,
Cat No. 10231X Form W-9 (Rev. 10-2007)
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (1lN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person Oncluding a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income.
Note. If a requester gives, you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
City of Ashland
LIVING
~&.
IF_ '1
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 $18,088 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 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 $18,088.
~ 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,
401K 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 54'1-488-6002 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.
.
~.I
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
EXHIBIT C
2008-2009
~OFCASE
11.IArt Bu~lock v. City of Ashland l~UBA]
i ,\[247 OtIS .Street (Helman ~aths) FInal Plan
I (contract Includes appeal, If any)
. I
I
I
ICASE NO. INOT TO
! EXCEED
ILUBA 2007-218 $10,000.00
i
!
1
I
I
j
I
~..~ .... ;.......:...................;;...;.;,...........................;..................................;.........;.;._..;.;........._.......................;;,;..............;........;....;,;..
..... ............................................................ -....-...... ................... .................-...................................
12. Art Bullock v. City of Ashland 07-3346-Z3
I (Nevada St LID Final Assessment) - (2007)
$10,000.00
lAppeal to Oregon Court of Appeals]
13. Art Bullock v. City of Ashland
Consolidated cases (2 cases)
\4. (2004 Nevada St LID cases)
CAA-131252 $10,000.00
CA A-133660
1(04-3971-Z3 &
1
,04-3972-E7)
i jl.Appeal to Court of Appeals (2 cases)] I
1".....'...............'........-....-..-'....."........................................~..,.........._.................,...,....._.....,........".........._.....,.....~..............................
............."'....,....................:...............}..............................................................................-...............................-...............................
................
15. Art Bullock, PhIl Lang, and Cobn Swales v. City iLUBA 2007-113 $10,000.00
! of Ashland I
! I
, !
11
I IlAPpeal to Court of Appeals] I
, !
16. State of Oregon ex reI Park St. Apartments, jAppeal No.
! LLC v. City of Ashland, Art Bullock and PhillA137118
i I
1 Lang, Intervenors I
i ' I
i I [Appealto Court of Appeals) . ... . I
b.IArt Bullo~k, Edward Pentkowski~ JudithI07~2167-Z2
I IPentowskiandMaryDuttonv. City of Ashland IBe111g appealed
11_ ITOTALS ;::::::teIY I
$10,000.00
$15,000.00
JENS SCHMIDT
Admitted in Oregon
jens.schmidt@harrang.com
H A R RAN G LON G GAR Y R U D N I C K P.c.
ATTORNEYS & COUNSELORS AT LAW
EUGENE OFFICE
August 8, 2008
Richard Appicello
Ashland City Attorney
20 East Main Street
Ashland, OR 97520
Re: Consolidated Contract for Personal Services
Dear Richard:
I have enclosed the original Consolidated Contract for Personal Services which has been signed
by my firm's President, William Gary. Please provide us with a fully signed copy of the contract
after it has been executed by the City of Ashland.
Thanks again for giving us the opportunity to help the City of Ashland with its legal work.
JS:kdp
Encl
00203382.DOC; 1
1001 SW FIFTH AVENUE, 16th FLOOR
PORTLAND, OR 97204-1116
PH 503.242.0000
F 503.241.1458
360 EAST 10TH AVENUE, SUITE 300
EUGENE, OR 97401-3273
PO BOX 11620
EUGENE, OR 97440-3820
PH 541.485.0220
F 541.686.6564
333 HIGH STREET NE. SUITE 200
SALEM, OR 97301-3632
PO BOX 12949
SALEM, OR 97309-0949
PH 503.371.3330
F 503.371.5336
Page 1 / 1
r.,
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
I I
PQ;Nl.lMBER
08438
DATE
7/23/2008
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
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
Quantity Unit ... Deseripti6n... .. Unilpr'iee Ext. Price
. .
Art Bullock, Edward Pentkowski, Judith 15,000.00
Pentowski v. City of Ashland - New
Appeal - Schofield 81.
Approved by Council 07/15/2008
Per attached contract
BeQinninQ date: 07/01/2008
Completion date: 06/30/2009
SUBTOTAL 15.000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN 8T FREIGHT 0.00
541-552-2028 TOTAL 15,000.00
ASHLAND, OR 97520
Accc)l.In~;NYmt;)~1' I:.'IrojeetNl.Il11 ber ..i "~ .'. ..J+ .. Account NUiilber projectNdrni)eJ' . A~~;;...... ....
.... ......
E 7 1 0 0 1 03 00 604 1 O( 1 5,000 00 i
!
I
LA/.
~-~~y
Au ized Signature
VENDOR COpy
Page 1 / 1
W4111
._~
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE
7/23/2008
P<:JNUMBER
08436
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
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
Quantity........ Unit 1< ., .... .... '. .. ..... ,. .... '.' . . . .' Unit'Pl'icfj ..... ...:;.:;<.,.; ..'
I ..... :", .'. .:
:.:
Art Bullock v. City of Ashland 10,000.00
Nevada LID - 2007 Assessment
Approved by Council on 07/15/2008
Per attached contract
BeQinninQ date: 07/01/2008
Completion date: 06/30/2009
SUBTOTAL 10.000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN 8T FREIGHT 0.00
541-552-2028 TOTAL 10,000.00
ASHLAND, OR 97520
.... ~ ')<.' .. .... .... . c' ,. a". ,<,,:" . .'. : " Accc:>uhtNumber .. ........... ..;..;.... ..: -- ..< d',? <i. ,,' , ".i':...
.. r'" ...~....... ..":"'~ . .', .
E 71 0.01 .03.00.60414( 1 0 000.00
.n ~ ~~V
A orized Signature
VENDOR COPY
I~ request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
Date of Request:
~"'" ul
;- ,
L :.(l,,~3<
fir '" 'I
; .., .<b~/"fYl.:..:. ,:
V,",.<.. . ..,...<;
')!.' ,"'....-,, ',_d.. '. _",
'" """ , , .'..', "
THIS REQUEST IS A:
D Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
e-
,JD\\~ SlWt
. SOLICITATION PROCESS
Small Procurement o Sole Source o Invitation to Bid
o less than $5,000 o Written findings attached . (Copies on file)
o Quotes (Not required)
Coooerative Procurement o Reauest for ProDOsal .
o State of ORIWA contract (CoPies on file)
Intennediate Procurement o OIher1[b~oonlract o Soeclal' Exempt
o (3) Written Quotes o Written findings attached
(Copies attached) r1 Copy of attached o Emergencv
o Contract # o Written findings attached
Desert. tion of SERVICES
O-WV1NtO b-.\ to '. OV\ 1. lC5.0 -' '. lo"
ilv ~ lLU\\' l~ V l\\tA il f- If - ~VI "'~ ~ 1.-1 b tb~1 , J-.
1\\ U .} -.. t\-~~WV\'
[Zj Per attached-PROPO&Al ~"'l ' \--
Item # Quantity Unit
Description of MATERIALS
Unit Price
Total Cost
D 000
Project Number ______. ___
~ -"4 ~:; \ L ~,;~.:~-.::"
~"~) f;_", "C.J~/J
'. ) . .
o Per attached QUOTE
tJ o~~
I' r~
Account Number1l.fl. ~1- ~b- D~ .ltb~M
* Items and services must be charged to the appropriate account numbers for the financia/s to reflect the actual expenditures accurately.
By signing this requisition fonn, I certify that the information provided above meets the City of ASh/~anp ic contractin
and the documentation can be provided upon request. "
Employee Signature.' L Supervlsor/Depl Head Signatur: '
G: Finance\Procedure\AP\Fonns\8_Requisition fann revised
Updated on: 61812005
~.,
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Page 1 / 1
P<D NtJMBE~
08437
SHIP TO: City of Ashland
20 E MAIN STREET
ASHLAND, OR 97520
Req. No.:
Dept.: ADMINISTRATION
Contact: Richard Appicello
Confirming? No
Qpantity Unit '.. Description .... .' UnitPric~. Ext.Ptice
Other cases to be assiQned as needed 20,000.00
Approved by Council 07/15/2008
Per attached contract
BeQinninQ date: 07/01/2008
Completion date: 06/30/2009
,
SUBTOTAL 20.000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 20,000.00
'u>.' ; :c.. Amount AccOuhtNulnt>er ... c" ~;..,,"'.i<' ......'S..... ".i ....
" ...f......... .'. '.' ..... ...... ..' .. '. .. I ........ u.
E 71 0.01 .03.00.6041 OC 20,000.00
~~
ASHLAND, OR 97520
~ J:- ~Slgna~r
VENDOR COpy
CITY OF
ASHLAND
A request for a Purchase Order
REQUISITION FORM
Date of Request: ~;,j.~,.6i']
THIS REQUEST IS A:
o Change Order( existing PO #
Required Date of Delivery/Service:
~r"""""~
.. ' ,-' '. .. .
.. c' .
.' :. ...,. . - ..' . ~ ~. .:.,
~ ........ , : ",
..;.; .i.fi~7~):'
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
Small Procurement o Sole Source o Invitation to Bid
o less than $5,000 o Written findings attached (Copies on file)
o Quotes (Not required)
Coooerative Procurement o Reauest for ProDOsal
o State of ORNlA contract (COpies on file)
Intermediate Procurement o Other government agency contract . o Special' Exempt
o (3) Written Quotes o Copy of contract attached o Written findings attached
(Copies attached) o Emeraencv
o Contract # o Written findings attached
SOLICITATION PROCESS
Description of SERVICES N \;
b'\\\C'( hYS it Y;{ 0.. ~\OlY1d
o Per attached PROPOSAL
Item # Quantity Unit
Unit Price
Total Cost
1-0 ODD
Project Number ______. _-_
o Per attached QUOTE
. .(~ ~
Account Number"]J].li .l~.OQ .lv.D~ f
* Items and services must be charged to the appropriate account numbers nancia/s to reflect the actual expenditures accurately.
By signing this requisition fonn, I certify that the information provided above meets the City of Ashland public contracting requirem ts,
and the documentation can be provided upon request.. 12
Employee Signature:~blicJ SupervlsorlDept. Head Signature: '
G: Fmnce\Procedure\AP\Fonns\8_Requisition form revised
Updated on: 61812005
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
Date of Request:
kJ,;a:.,i)K ']
~" .'. .....'1
.' " :.' .' ."; . ~
; .' .....:."""" ...;" ......
1", ..,~,Dfr,,:
THIS REQUEST IS A:
o Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement o Sole Source o Invitation to Bid
o Less than $5,000 o Written findings attached _ (Copies on file)
o Quotes (Not required)
Coooerative Procurement o Reauest for ProDOsal
o State of ORIWA contract (CoPies on file)
Intennediate Procurement o Other government agency contract o Soeclall Exempt
o (3) Written Quotes o Copy of contract attached o Written findings attached
(Copies attached) o Emeraency
o Contract # o Written findings attached
I
~ -t. Q:ultbU( I tU~li
04 ~f ~&\,\~
o Per attached P~
Item 1# Quantity Unit
Description of MATERIALS
Unit Price
Total- Cost
Project Number ______. ___
o Per attached QtIOTE
r~.?J OJ4"~
Account Number JJ]..D!. -D.? j).D. ~~~ d- - ~
· Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition form, I cerlify that the information provided above meets the City of Ashland pu
and the documentation can be provided upon request. .
Employee Signature:
Supervisor/Dept. Head Signatur
G: Finance\Procedure\AP\Fonns\8_Requisition form revised
Page 1 / 1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE
7/23/2008
P<a:>NI;;.IMBER
08439
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
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
Quantity Unit . Description . UhitP.ri(;~i .... ..... . .',
. .,..'. "
State of OreQon ex rei Park St. Apts v. 10,000.00
City of Ashland, Bullock, LanQ
Approved by Council 07/15/2008
Per attached contract
BeQinninQ date: 07/01/2008
Completion date: 06/30/2009
SUBTOTAL 10.000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN 8T FREIGHT 0.00
541-552-2028 TOTAL 10,000.00
ASHLAND, OR 97520
AceoulltNul1lber Proje(;tNlJl1lber .. Amount '." Account NlJl1lber Pr()j~c::l.Nt.iffl~er, I:; ........, .'. '.'.../'...:.......,...;..
"., ......'
E 7 1 0 .0 1 .03 .00 .604 1 OC 1 0,000.00
I
I
#. ~Ori~!.:re
VENDOR COpy
A ,request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
D Change Order( existing PO #
Date of Request: 1,:tJi. ilK]
Required Date of DeliverylService: ~+:j,&gGb~1
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement o Sole Source . 0 Invitation to Bid
o Less than $5,000 o Written findings attached . (Copies on file)
o Quotes (Not required)
Cooperative Procurement o Reauest for Proposal
o State of ORmA contract (CoPies on file)
Intennediate Procurement o Other government ~ contract o Soeclal' ExemDt
o (3) Written Quotes rif Copy of~L o Written findings attached
(Copies attached) o Emeraency
o Contract # o Written findings attached
Item # Quantity Unit
Description of MATERIALS
~
Unit Price
Total' Cost
Project Number ______. ___
o Per attached QUOTE
rM f~~
Account Number1Q . hi...\l? ~1. .Io.\)~U.lJv @
* Items and services must be charged to the approp~ account numbers for the financia/s to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meets the City of Ashland pu
and the documentation can be provided upon request. .
Employee Signatu
Supervisor/Dept. Head Signatur
G: Finance\Procedure\AP\Forms\8_Requisition form revised
Page 1 / 1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE
7/23/2008
PG>NUMBER
08440
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
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
Quanti" '
Description
Art Bullock, Phil LanQ, Colin Swales v.
City of Ashland, LUBA
Appr Council 07/15/2008
Unit Price
Ext Price
10,000.00
BILL TO: Account Payable
20 EAST MAIN 8T
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
10 000.00
0.00
0.00
10,000.00
,.. RrojjctiNlJl1lber , Amount Ac(;ount'.Nurnber Proj~.~lNlJm~~r <'..... ."'.,.... i',; ........
.... .,..,. .,. ......
E 7 1 o. 0 1 .03 .00.604 1 OC 1 0 000.00
~ ~?~
VENDOR COpy
CITY OF
ASHLAND
A request for a Purchase Order
REQUISITION FORM
Date of Request:
\~it~jn./}:$;]
Er...........,1
.-. .. ." ' ' ..
. ., ..' ,"" ,'- - -...... ','
: ...... .:.. :.'C .,'. :
~;,- ,~i]J).~'1;~jt
THIS REQUEST IS A:
o Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement o Sole Source o Invitation to Bid
o Less than $5,000 o Written findings attached . (Copies on file)
o Quotes (Not required)
Coooerative Procurement o Reauest for Proposal
o State of ORmA contract (COpies on file)
Intennediate Procurement o Other government ~ contract o Soeclal' ExemDt
o (3) Written Quotes ~ Copyof~l~~ o Written findings attached
(Copies attached) o Emenlencv
o Contract # o Written findings attached
Per attached PROPOSAL
Item # Quantity Unit
Description of MATERIALS
\ . .
Unit Price
Total' Cost
~
Project Number ______. ___
o Per attached QUOTE
. . / ~ f~ez-u-
Account Numbert L~ - H. h2- h t -lJJL 1JH( €3
* Items and services must be charged to the appropriate account numbers for the financia/s to renect the actual expenditures accurately.
By signing this requisition fonn, I certify that the infonnation provided above meets the City of Ashland public contractin
qnd the documentation can be provided upon- request. .
,ployee Signature~ ~ D~ Supervisor/Dept. Head Signature:
Updated on: 6/812005
~\Procedure\AP\Fonns\8_Requisition form revised
Page 1 / 1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
gC),'iNl:JM13ER
08441
DATE
7/23/2008
I I
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
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
Quantity Unit I , Desc:tiplion Unit Price Ext.,Price
"
Art Bullock v. City of Ashland (LUBA) 10,000.00
Otis St
Approved by Council 07/15/2008
Per attached contract
BeQinninQ date: 07/01/2008
Completion date: 06/30/2009
SUBTOTAL 10.000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 10,000.00
ASHLAND, OR 97520
~~t:Ol.Jl'IlNumt:?~t projet:t J\lLJ m ber AmoUht }\ecp unlNLJ m~er .. Project N ~~r " T
, um ,'.
E 7 1 0 0 1 0 3 0 0 6 0 4 1 Q( 1 0,00 0 0 0
~~rl~~~~V-
VENDOR COPY
A r~quest for a Purcha,se Order
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
o Change Order{ existing PO #
Date of Request: ~,~,5t.Lbbtl
Required Date of Delivery/Service: i,~;j;G~f~,1
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
.\~ hrYl! t~~
'SOLICITATION PROCESS
Small Procurement o Sole Source o Invitation to Bid
o Less than $5,000 o Written findings attached . (Copies on file)
o Quotes (Not required)
Cooperative Procurement o Reauest for Proposal
o State of ORmA contract (CoPies on file)
Intennediate Procurement o Other governj1lent agency contract o Soecial' Exempt
o (3) Written Quotes Rihl b:\- o Written findings attached
(Copies attached) o Copy of-eentract attached .
o Emeraency
o Contract # o Written findings attached
Item # Quantity Unit
Description of MATERIALS
Unit Price
Total Cost
ID. ODD
Project Number ______. ___
o Per attached QUOTE
. . / tP--C f~~
Account Number]i~. H..P3- J2~. Jp~ ~
1r Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requireme ts,
and the documentation can be provided upon request.
Employee Signature:j\iJb{l}~\kJ
Supervisor/Dept. Head Signature:
G: Finance\Procedure\AP\Forms\8_Requisition form revised
Page 1 / 1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE
7/23/2008
I I
P(!).Nt)MBER.
08442
VENDOR: 004254
HARRANG, LONG, GARY, RUDNICK, ATTORNEY~
POBOX 11620
EUGENE, OR 97440
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
Deseription
Art Bullock v. City of Ashland,
Consolidated Cases, Nevada 2004 LID
Approved by Council 07/15/2008
10,000.00
Per attached contract
BeQinninQ date: 07/01/2008
Completion date: 06/30/2009
BILL TO: Account Payable
20 EAST MAIN 8T
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
10000.00
0.00
0.00
10,000.00
A.(;(;QurjfNUJ']jp~" p(oj~<:fNufflJl,~r ArnoUht AccOlJnfNumber .... ....\/............ ...... '........G
, '.' /
E 7 1 0 0 1 03 00 604 1 O( 1 0,000 00
~J.
~ ~rdY
A orized Sianature
VENDOR COPY
C I T yO F
ASHLAND
A request for a Purchase Order
REQUISITION FORM
Date of Request:
~.,.'''',;''',','':'''','"C'''^''\
.' ," ..jj.... b~
~.:"':' .,.... ,; ,', ..... ;.:,."' .'.,'.
,.:.<~. .j;,,~,,~ ~':"~'.. ,;"."".~ . ," .: .,; '. ,:.
~..........'..'l
.' .,.- .. .. . . .
.~. . . . '.' '. -' '. . ,'-~
._ '.' c....;..,...;.;. ....;. ......;, ,',
:; "::,:.:.x~<. "",'F "J.
~ '." ."....~~
THIS REQUEST IS A:
o Change Order( existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
Small Procurement o Sole Source o Invitation to Bid
o Less than $5,000 o Written findings attached . (Copies on file)
o Quotes (Not required)
CooDeratrle Procurement o Reauest for Proposal --;-
o State of ORfflA contract (COpies on file)
Inte~iate procurement o Other~~rcontract o Soeclall Exempt
o (3) Written Quotes ~ CopYof~~ o Written findings attached
(Copies attached) o EmerGencY
o Contract # o WOtten findings attached
SOLICITATION PROCESS
o Per attached-PRQPeSAt:-
Total Cost
Description of SERVICES, i
.~ 97\r1\\bl>L If. lit\,) W '11
Item # Quantity Unit
Description of MATERIALS
Unit price
Total' Cost
10 Oh
(~
Account Numbet1Lb. ~l. .D~I) J)~.lLQ~
· "ems and selVices musl be chal!led to the appropriate ec<:OUnt numbe1s forthe financials to relied the ectual expendnures eccurateIy.
,
fJ~ aP'
r~
o Per attached QUOTE
Project Number ______. ---
By signing this requisition fonn, I 00. rtify t.hat th,e information provided above meets the City of AShland~Ubr confrac/ing requireme ·
and the documentation can be provided upon request.
Employee Signature: ~ ~it./ Supervlsor/Dept. Head Signature:
"
Updated on: 61812005
G: Finance\procedure\AP\Forms\8_Requisition foon revised