HomeMy WebLinkAbout2009-191 Contract - Pathway Enterprises
,.
-.' "!,
C I T Y OF CONTRACTOR: Pathway Enterprises
ASHLAND CONTACT: Don Libby, Richard Simpson
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 655 Washington Street, Ashland, OR 97520
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-488-1536
DATE AGREEMENT PREPARED: AUQust 7, 2009 FAX: 541-488-5948
BEGINNING DATE: Julv 1,2009 COMPLETION DATE: June 30, 2010
COMPENSATION: Janitorial Services FY 2010 - Grove $10,199.48, Service Center $9,622.78. StreeUShop
$4,289.61, Police $8,757.72, City Hall $6,739.26, Community Development $15,389.80, Municipal Court
$6,739,26, Total Annual Cost $61,737.91, Total Monthlv Cost $5,144.83 - Per attached costina workbooks,
GOODS AND SERVICES TO BE PROVIDED:
ADDITIONAL TERMS:
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any 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 any 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 worker-like 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 provide all goods in accordance with the standards and specifications, no later
than the date indicated.'above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. 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, unless a
separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 279B.220, 279B.225, 279B.230, 279B.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and 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 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.
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 proximately caused by the negligence of City,
9, 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:
Contract for JANITORIAL SERVICES
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 1 of 5
"
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. Oblication/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.
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.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.11 0 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license. '
13. 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.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. 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 urder the Contract; if it loses its ORF status pursuant to
the ORF Rules or loses any license, certificate or certification that is required to perform the work or to quaiify as a
ORF if Contractor has qualified as a ORF 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.
16, Insurance, Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. 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 shali include contractual liability coverage for the indemnity provided under this contract.
c. 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,
d. Notice of cancellation or channe. There shall be no cancellation, material chance, reduction of iimits or
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 2 of 5
.,
inte'lt not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates 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 contractor's insurance is primary and non-contributory. 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.
17. 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.
18. 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.
19. 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.
20. Prior Approval Required Provision. Approval by the City of Ashland Councilor the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
CONTRACTOR CITY OF ASHLAND:
BY
~~~
UL-&IU-- j)1
Print Name
BY
TITLE
6~f) ,)", <:d u. r
/ t
DATE
DATE
'1/Itf-)01
/ I
CONTRACT AWARD AND FIN
By:
i.-
Date:
W-9
One copy of a W-9 is to be submitted
with the signed contract and it will be
kept on file in the Finance Department
ACCOUNT #
~ /' tfJ C? E3 ;:v! t9-O &; O.:L~ C;--.=L
(For City purposes only)
PURCHASE ORDER #
09(851
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 3 of 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: 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 (iii) 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 following
criteria:
V'
..;
I
'/
(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 of 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.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) 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.
con~~r~
<? / If//)1
'(Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 5
PRODUCER
.
CERTIFICATE OF LIABILITY INSURANCE ~i~~~.\ I OAT;~.;;=}
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
-ACOt'lO.
W9stern States Ins. - Medford
38 N. Central Ave Suite 100
Medford OR 97501
Phone: 541-779-1321 Fax:541-779-91B7
Pathway Enterprises, Inc.
655 Washington St .
Ashland OR 97520
INSURERS AFFORDING COVERAGE
INSUR[RA: Philadelphia Ins
lNSURERB:
INSURER C:
INSURER 0:
INSURER E:
NAlC #
INSURED
Co
COVERAGES
THE POLICIES OF INSURANCE LISTED BElOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT. TERM OR CONDITION OF f4NY CONTRACT OR OTHER DOCUMENTWITtI 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 CONDmONS OF SUCH
POUCIES. AGGREGATE UMITS SHOWN MAY HAVE SEEN REDUCED BY PAID ClAIMS.
~~~1i TYPE OF INSURANCE I POUCY NUMBER I ~~~~~J~foE~E IP8mv;~..%~~N I LIMITS
~LLIABILlTY EACH OCCURRENCE $1,000 000
A X X COMMERCIAL GENERAL LIABILITY PHPK416727 05/11/09 05/11/10 PREMISES Eaoccureoce\ .200 000
CLAIMS MADE ~ OCCUR MEO EXP (Ant one person) .10 000
~PrOfeSSional Liab PERSONAL & AOV INJURY , 1 000,000
GENERAL. AGGREGATE .3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PROOUCTS - COMP/OP AGG . 3,000 000
!xl POLICY n ~~ n LOC Emp Ben. 1 000 000
~TOMOBILE LlABlUlY COMBINED SINGLE LIMIT sl,OOO,OOO
A X ~ ANY AUTO PHPK416727 05/11/09 05/11/10 (E88CCiclent)
- AlLOWNEDAUJOS BODILY INJURY
(Per person) .
- SCHEDULED AUTOS
HIRED AUTOS 900lL Y INJURY
- .
NON-oWNED ~UTOS (Pera~IJ
-
- PROP(RTY DAMAGE .
(Peracci:ient)
~=r UABlLlTY AUTO ONLY. EAACCIDENT .
ANY AUTO OTHER THAN EA ACC .
AUTO ONlY: AGG .
EXCESSlUMBRELLA LlA91UTY EACH OCCURRENCE .3,000 000
A X ~ OCCUR o CLAWS MADE PHUB270976 05/11/09 05/11/10 AGGREGATE .3,000 000
.
~ ~ECUCTlBLE .
X RETENTION no 000 .
WORKERS COMPENSATION AND I ITORYLIMITS I IUJ~
EMPLOYERS' LIABIUTY
A~:V PRnpi1I~TQP_Ip_ol.,P.TNF?!E"'EClJT1VF. E.L EACH ACCIOENT .
,
OFFICERlMEMBER EXCLUDED7 I E.L. DISEASE - EA EMPlOYEEi $
~~~I~~~~V~~~S below E.l. DISEASE. POLICY LIMIT I S
OTHER I
DeSCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCl.USIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is additional insured.
oiTY RECORDER
CERTIFICATE HOLOER
CANCELLATION
City of Ashland
Attn: Kari Olson
90 N Mountain
Ashland OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAHCELl.ED BEfORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WROTEN
NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL'
IMPose NO OBllGATKlN OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08)
t:./G
.@ACORDCORPDRATION1988
. ' '..
...
. saifcorporation
400 High Street SE
Salem. OR 97312.1000
Toll Free 1-800-285-8525
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE
MAIL TO:
CERTIFICATE HOLDER:
CITY OF ASHLAND
ATT KARl OLSON
90 N MOUNTAIN
ASHLAND, OR 97520
CITY OF ASHLAND
ATT KARl OLSON
90 N MOUNTAIN
ASHLAND. OR 97520
The policy of insurance listed below has been issued to the insured named below for the policy
period indicated. The insurance afforded by the policy described herein is subject to all the
terms exclusions and conditions of such policy,
POLICY NO,
524679
INSURED:
PATHWAY ENTERPRISES
655 WASHINGTON ST
ASHLAND, OR 97520-3705
POLICY PERIOD ISSUE DATE
04/01/2009 to04/01l2010 06/01/2009
BROKER OF RECORD:
RUSS SCHWEIKERT
801 O'HARE PARKWAY #101
MEDFORD, OR 97504
LIMITS OF LIABILITY
Bodily Injllry by Accident $500,000 each accident
Bodily Injury by Disease $500.000 each employee
Bodily Injury by Disease $500,000 policy limit
.
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject
to change at any time in the future,
This certificate is issued as a matter of information only and confers no rights to the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the policies
above.
AUTHORIZED REPRESENTATIVE
~r?}>- J' Rc4ii~
-....
President and CEO
CITY RECORDER
INSURED
"
,
r:'~ 1
cnY RECORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND. OR 97520
(541) 488-5300
Page 1 /1
"
8/5/2009
!!1M.\P.01NI!IMBERiL~
09139
fliZ&f1tDATE!;~
VENDOR: 005727
PATHWAY ENTERPRISES INC
655 WASHINGTON STREET
ASHLAND, OR 97520
SHIP TO: Ashland Building Maintenance
(541) 488-5358
90 N MOUNTAIN AVENUE
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dopt.:
Contact: Dale Peters
Confirming? No
~~tJarillNl~~ ~UiirtY]~11~;/1~1~~50~~tWjitft:4:a;je~2~~llflftSr~'1)escriDtl-onV!k~{j~;;;~:?';~)1:ir;rs;~:]l~~~~Il]!Jl%.Y~ f:8~~unH~.RriCYe~ ~~E.xfJrnHml1NJ
Janitorial Services - FY 2010, Grove -
$10.199.48, Service Center - $9.622.78.
Street/Shop - $4.289.61; Police -
$8.757.72, City Hall- $6.739.26,
Community Development - $15.389.80.
Municipal Court - $6.739.26, Total
annual cost - $61.737.91, Monthly cost
- $5,144.83
61.737.91
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
61 737.91
0.00
0.00
61,737.91
~~lIIrrm~~ _P1'OjOcfINUnl~ji fb~iii~ i\W...cCoUiit!N~ ~p.;oject1Nu;nDe~ ....~mo~4,;f~
IE 410.08.24.00.60235 61 737.91
~j,
- e _ r!J~t
Auth~zed Signature
VENDOR COPY
I FORM tHO I
CONTRACT APPROVAL REQUEST FORM
}D-t) #- 5/J! I
Contractor/Consultant:v:J .. // _ .rr-,
f~ IZ.%-A- ~ (.~/L 'i'- ".
~r attached contract ~ (. ~c d..-f' .",y~L/?~
PUBLIC CONTRACTING REQUIREMENTS - Solicitation Process
CITY Of
ASHLAND
0 Exempt from Competitive BiddinQ 0 Invitation to Bid (Copies on file) 0 Emeroencv
Reason for exemption: 0 Written findings attached
0 Quote or Proposal attached
0 Small Procurement & Personal Services 0 Request for Proposal (Copies on file) Coooerative Procurement
less than $5.000 Piease check one: 0 Sfate of Oregon
Nole: Tofal confract amount. including any o Goods & Services Contract #
amendments may not exceed $6.000 0 Personal Services o State of Washtngton
Intermediate Procurement 0 Sole Source Contract #
GOODS & SERVICES 0 Written findings attached o Other government agency contract
$5.000 to $75.000 0 Quote or Proposal attached Agency
o (3) Written Quotes / Contract #
PERSONAL SERVICES o Special Procurement "c:::)t{...l1 ~ Interagency Contract
$5.000 to $50.000 ~ritten findings attached 6! R Agency
o (3) Written Proposals , Quote or Proposal attached Contract #
Have all public contracting requirements been satisfied?
YES
/
If "NO", City Council approval is required. City Council approval was received on
Have funds been budgeted forthe purpose ofthis contract?
YES
~
If "NO", City Council approval is required. City Council approval was received on
Please provide: Account Number
- -
-- -- -- ------
Is the amount of the contract less than $25,OOO?
YES
If "NO", Legal review is required. Contract was "Approved as to form" by the Legal Department on
Is the amount of the contract less than $75,000 for Goods & Services
or $50,000 for Personal Services?
YES
~
If "NO". City Council approval is required. City Council approval was received on
Is the contract for a period of 24.months or less?
YES
~
If "NO", City Council approval is required. City Council approval was received on
Please provide terms: Start date: tJ? /& f (tJ-l. Completion date. tOG /e-~ (r 0
Can the contract be terminated for convenience thirty (30) or fewer days
. following delivery of written notice to the contractor? YES
~.
NO
If "NO", City. Council approval is req . d. City Council approval was received on
(Date)
Prepared by:
4/ €--h'0 -t'
Please cir~~^~,~
~
*,7-. - . tF- v=
0.. . Coo Pf~Io7'
Not Approved
Department:
Date:
Form #10 - Contract Approval Request Form, Page 1 of 1,
A request'for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
D Change Order(existing PO #
Date of Request: 127' ~\ [) ~ I
Required Date of Delivery/Service: 1 I
::P14T1-l~ Ei\)-I:?I2-PR'S~ II0c.
C"SS i<\<;H''''<:::TI''lIV s-I:.
ASI-l'-IAI'->i:>, OR 9'r,f2.Cl
5 't, -SSe. - rc,Ot'e,O
S'i \ -552.- t.bt;, I
])ON L 1,10."
,
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
Intermediate Procurement
o (3) Wotten Quotes
(Copies attached)
SOLICITATION PROCESS
Small Procurement
o Less than $5,000
o Quotes (Optional)
Copy of contract attached
0 Invitation to Bid
\<.F (Copies on file)
0 Reauest for PrODosal
(Copies on file
S eciall xem t
0 Wrillenfin a ached
0 Quote or Pro osal attache
0 Emeraencv
0 Wotten findings attached
0 Quote or Pro osal attached
Contract #
Description of SERVICES
:T '4-1'-.; I lo e-. ~) S;S,c-() I Cc;.'
(!) {L c..: -b.( 15ld/~
D Per attached PROPOSAL
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
o Per attached QUOTE
Project Number ______. ___
AccountNumber~f1Q..re ?8-!?9 ~Q~?2
'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 requirements,
and the documentation can be provided u on request.
Employee Signature:
SupervisorlDept. Head Signature: ~....;.. R.lk-
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 7127(2009