HomeMy WebLinkAbout2009-250 Agrmt Addendum - Identix Inc
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Nov. 20. 2009 11 :31AM
No. 6966
P. 4/9
L 1 Identity Solutions: BIometrics Division Customer Service
Time and Material Rates
Non-Contract Labor R.t8ll
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On-Slte Support for Custome..vEnd Users
On.Slte Support for L 1 Identity SOl ulloM: Biometrics Division
PartnersIResellers
Help Desk Technical Support and Rep.lr Services
Help Desk Tecl1nlcal Support and Repair Seivices Partne..vRe...llers
for L 1 Idantity Solutions: Biomatr1cs Division Partne",/Resallers
. All Labor has 1 hour minimum. Addilional expanses see below.
'Addltlon.1 Expense Rates
Labor Rete
$200,00 per hcur plus expensas'
$135.00 per hour plus expen.....
$130.00 per hour plus materials
$80.00 per hour plus materials
~
Travel Tlma
Mileege
Air Fare
Per Diem (Overnight Stay Only) Actual axpense
Included In Per Diem are Meals, Rental Vehicle: Parking, Toll, and Lodging.
Addltlon.1 Servfoes .
Labor Rate
$60,00 per hour
$.85 per mile
Actual expense
~
Pre-Malnt9llance S~e Inspection
Training Full Day
Training Hall Cay
Raplacement Parts
LabOr Rete
$660.00 Flat lee plus expen""s'
$B50.oo Flat fee piUS e""enoe.s'
.$425 Flat Fee plus expenses
Refer to current price list
$}Istam Modifications
Moclffoatlon
IP Address and other minor configuration changes
Shlcolna Chero""
The pOlicy for shipping Non-Contraat Repair Parts to the Custom.. from the Bloomington, MN Factory or Ihs Ontarfo. CA
P.rts Depot Is as follows:
1. PriCing for Reoaira~le Replacement Parts is established with the underslendlng that the "'ailed' Repairable Pari will be
returned to the Factory as -Trade In', Notify Customer ofthis prior to shipment
2, Customer will be billed for all Repairable Parts Returns that are not returned tc the factory wilhin 14 WOrking days.
3. Customers may cIIoose 10 send Repairable Parts to Factory on a 'Repair and Retum" basis and will be billed at the
est\lbllshed Repair Services Rate, plus any necessary repair parts. .
All Customer orders beyond the onglnal systems pUrchase order should take Into con.ldera~on these rates when pricing, 'Non-
Contract Labor' refers to ell labor provided 10 Customers/Compenles withcut . Warranty cr Maintenance Agreement in place. II also
refers to any oeMces not covered by a specifio Maintenance Agreement.
PrlC88 are Subject to Change wIthout Notice
FSP-010
Rev 14
Attachment 2
Nov, 20, 2009 11: 32AM
No. 6966 P. 5/9
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An L-l Identity Solutions Company
Ashland Police Department
1155 E Main St.
Ashland, OR 97520
November 20,2009
(TP-300XDFS-ED, # 9199-01)
Kelly Haptonstall:
Our records indicate that the maintenance/wl\lTanty coverage on your T ouchPrint" fingeIprint system will
soon lapse or has lapsed. As of this date, we have not received a reply regarding your intentions to continue
maintenance coverage for your TouchPrint" System. Your maintenance coverage ends on the .contract end
date.'You have one of the following options: .
Option I: If you have a non-contracted maintenance status, Service will be provided by IDENTlX at our
Customer Service Time and Material Rates (see attached fotm).
Option 2; You may sign the attached maintenance agreement addend\IIII and fax it back to us at 952-852-
8747.
Option 3; If you choose to re-new your maintenance agreement after your maintenance agreement has
lapsed, a pre-maintenance site inspection will be required before your contract can be reinsUlted. An on-site
inspection is priced at $850,00 pillS actual travel and per diem expenses (actual travel and per diem expenses
not to exceed $2,000.00), plus the cost of any replacement parts. Once this has been completed you are able
to sign up for maintenance, \
We recommend continued maintenance coverage, as in some instances a single service call can be equal to
or greater than the cost of yearly maintenance, Regardless of your decision in this matter, IDENTlX remains
committed to providing quality maintenance service to your organization. If you have any questions or
concerns, please call me at 952.945-3373.
Sincerely,
~~ VCU'\ LL~t-.
Penny Van Lith
Contracts Administrator
'JDENTIX INCORPORATED, 5705 West Old Shakopee Road, Suile 100, Bloomington, MN 55437
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Nov, 20. 2009 11 :32AM
No, 6966 p, 6/9
IDENTIX INCORPORTED
SYSTEM MAINTENANCE TERMS AND CONDITIONS
for use with
U.S. End User Customers
covering
Identix@ Live Scan Product Line
L GENERAL SCOPE OF COVERAGE
Subject to payment in full of the applicable
maintenance fees for the system ("System") described
in Identi" Incorporated's ("Identi,,") current
Maintenance Agreement Addendum ("Addendum")
with customer ("Customer"), Identix; or its authorized
agents or subcontractors, shall provide the System
maintenance services ("Services") set forth and in
accordance with the tenns herein (this "Agreement")
and the Addendum. The tenns of the Addendum are
hereby incorporated into this Agreement by this
reference.
II. MAINTENANCE SERVICES
The Services provided by Identi" are those services
selected by Customer from one or more of the
following maintenance services programs;
A. Included With All Remedial Maintenance Services,.
InCluded With All Remedial Maintenance Services are
as follows:
· . Unlimited 2417 telephone technical support for
System hardware and. software from the
Identix TouchCare Support Center via Identix .
toll free telephone number.
· TouchCare Support Center managed problem
escalation, as required, to Ident!x' technical
support staffto resolve unique problems.
· Identix shall furnish all parts and components
necessary for the service and maintenance of
the System. Replacement parts shall be sent to
the Customer. All replaced defective parts
shall become Identix' property. Identix shall
determine if a replacement part is necessary,
Replacement parts and Components may be
new or refurbished. Unless otherwise agreed
by Identix, replacement parts and components
needed at international destinations shall be
shipped by Identix to the Customer-specified
United States destination, and the Customer
shall arrange for shipment of the parts and
components to the. fmal international
destination, In the event Identix ships
replacement parts and components to an
international destination, the Customer shall be
responsible for all shipping expenses, duties,
V ersionl12007121 Marcb2007
tariffs. taxes, and all other delivery related
charges,
· Identix shall make available to Customer one
copy (in electronic or other standard form) of
eacb Update (defmed herein) for those System
components that are developed by Identix and
. for which Identix, in its sole discretion, elects
to develop and generally make available to
customers whose Systems are under warranty
or under a current Identix Maintenance
Agreement Addendum. Customer shall
provide Identix with continuous network or
dial-up access to the System (whether stand
alone or connected to a central site), lind
Identix shall deliver the Update via this remote
means of delivery, In the event continuous
network or dial-up access is not available for
24/7 Maintenance Services and 9/5
Maintenance Services Customers, then Identix
shall install .the Update during any
subsequently scheduled on-site visit by Identix
for service of the System, An "Update" means
a new release of such System software
components that are developed by Identix
which contain (i) bug fIXes, corrections, or a
work-around of previously identified errors
with such software, or (ii) minor
enhancements, improvements, or revisions
with substantially' similar (but not new)
functionality to the original licensed System
software.
B. 24/7 Maintenance Services. Identix' 24/7
Maintenance Services are as follows:
· Customer will receive a telephone reSponse to
service calls within one (I) hour from the time
the Customer places a service call with
Identix' Help Desk.
· Identix' Help Desk will attempt problem
resolution via telephonic verbal and dial-in
troubleshooting prior to dispatching an Identix
field service engineer to Customer's facility
for on-site service.
· If on-site service is necessary, such service
. shall be provided 24/7, including holidays,
Identix shall use its best efforts to have an
Identix' field service engineer at the
Customer's facility within four (4) hours from
the time the engineer is dispatched by Identix'
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Nov. 20. 2009,11 :32AM
Help Desk for custOmers located within a 100
mile radius of an authorized Identix' service
location and within 24 hours for cusWmers
located outside such 100 mile radius.
· At no additional charge, Identix will provide
Customer with up to four (4) Customer-
requested type of transaction ohanges to
existing type of transaction applications;
provided, however, that any such type of
transaction change does not, in the sole
opinion of Identix' Development
Management Team, requlre a signlflcant
development effort. In suph event, Identix
will provide Customer with a quote for
developing and providing Customer with any
such applications and changes. Table updates
are treated as Updates and will be made
available to Customer in accordance with
Section ITA of this Agreement.
C, 2/5 Maintenance Services. Identix' 915
Maintenance Services are as follows;
· Customer will receive a telephone response to
service oalls within one (1) hour from the time
Customer plar;es a service call with Identix'
Help Desk.
· Identix' Help Desk will attempt problem
resolution via telephonio verbal and dial-in
troubleshooting prior to dispatching an Identix
field service engineer to Customer's facility
for on-site service.
· If on-site service is necessary, such serviOe
shall be prOvided nine (9) business hours (that
is, 8;00 a.m. to 5:00 pm,) per day, five
business days per week. Identix shall use its
best efforts to have an Identix' field service
engineer at Customer's facility within eight (8)
working hours from the time. the engineer is
dispatched by Identix' Help Desk if
Customer's facility is located within a 100
mile radilL$ of an authorized Identix' service
location and within 24 hours if Customer's
facility is lor;ated outside such 100 mile radius.
· Upon Identix' acceptance of Customer's
request for after hours service, Customer shall
pay for suoh after hours service on a time and
materials basis 'at Identix' then cUlTent rates.
· At no additional oharge, ldentix will provide
Customer with up W four (4) Customer-
requested type of transaction changes to
existing type of transaction applications;
provided, however, that any $ueh type of
transaction change does not, in the sole
opinion of Identlx' Development
Management Team, require a significant
VersionI12007121Man:h2007
No, 6966 P. 7/9
development elTon. In such event, Identix
will provide Customer with a quote. for
developing and providing Customer with any
such applications and changes. Table updates
. are treated as Updates and will be made
available to Customer in aocordance with
Section II.A. of this Agreement.
D. HelD Desk Maintenance Services. Identix' Help
Desk Maintenance Services are as follows:
· The Services do not inolude any Identix on-site
maintenance services. The Customer agrees to
provide the on-site personnel to assist the
ldentix Help Desk with troubleshooting,
module replacement, and installation of
Updates, as required.
· Customer shall maintain at least one (i)
Identix trained System manager on the
Customer's System support staff during the
term of such Services period contained in the
applicable Addendum, and suoh Customer.
System manager shall be responsible for
periodically backing.up System software in
accordanoe with Identix' periodic
requirements. Unless otherwise agreed in
writing by Identix, the Customer shall be
responsible for the installation of eaoh Update.
· Customer will reoeive a telephone response to
service calls within one (I) hour from the time
the CusWmer places a service call with
Identix' Help Desk,
· Identix shall furnish all parts and components
necessary for the maintenance of the System.
Identix' shipment of a replacement part to
Customer will be initiated promptly after the
Identix' Help Desk determines the need for
such item. Replaoement part orders initiated
prior to 3:00 p.m. Central shall be shipped the
same business day, where orders initiated after
3:00 p,m, Central sball be shipped the next
business day, All shipments are made via next
day priority air.
· If a defective 'part i. required by Identix to be
returned to Identix, the packaging material
used in shipment of the replacement part must
be reused to return the defective part, [Note:
defective. parts are not repaired and returned to
Customer. Customer will be invoiced for any
defective parts that are not returned to Identix
within two (2) weeks after receipt of the
replacement part, ldentix is not responsible for
any markings (i,e., asset tags) that Customer
may plar;e on System components. It is
Customer's responsibility to remove such
markings.]
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Nov, 20. 2009 11: 33AM
· Upon Customer's request for ldentix on-site
service, ldentix shall use its best efforts to have
an Identix field service engineer at the
Customer's facility within 48 hours from the
time the engineer is dispatched by ldentix'
Help Desk, Customer shall pay for such on-
site service on a time and travel basis at
Identix' then current rates and travel policies,
respectively. Prior to dispatch of an Identix
engineer, Customer shall either provide ldentix
with a purchase order ("P,O."), complete
IdentiJ(' P,O. Waiver fonn, or provide Identix
with a valid credit card number.
E. Preventive Maintenance Services. Identix'
Preventive Maintenance Services are as follows:
· Preventive maintenance service calls consist of
System cleaning, verification of calibration,
and verification of proper System
configuration and operation in accordance with
Identix' specifications for such System,
Identix and Cusromer will seek to agree upon
the scheduling of the preventive maintenance
service call promptly after commencement of
the tenn of this Agreement and the
commencement ofany renewal tenn.
· Preventive maintenance service calls are only
available. in connection with ldentix' 24/7
Maintenance Services and Identix' 9/5
Maintenance Services offerings. Preventive
maintenance service calls are priced on a per
call basis in accordance with Identix' then
current published prices for such Services,
Preventive Maintenance Services may not be
available for certain System components.
m. EXCLUSIONS FROM SERVICES
A. Exclusions, The Services do not include any of the
following:
. System relocation.
. Additional training beyond that amount or level of
training originally ordered hy Customer.
· Maintenance support or troubleshooting for
Customer provided communication networks.
· Maintenance required to the System or its parts
arising out of misuse, abuse, negligence,
attachment of unauthorized components (including
software), or accessories or parts, use of sub-
standard supplies, or other causes heyond Identix'
control. .
· Maintenance required due to the System being
modified, damaged, altered. moved or serviced by
personnel other than Identix' authorized service
representatives, or if parts, accessories, or
V ersionl/2007/21 Mareh2007
No. 6966 p, 8/9
components not authorized by Identix are fitted to
the System.
· Maintenance required due to failures caused by
Customer or Customer's software or other
software, hardware or products not licensed by
Identix to Customer,
· Providing or installing updates or upgrades to any
third party (i.e" Microsoft, Oracle, etc.) software.
. Providing consumable parts and components (i,e"
platens, toner cartridges, etc.); such items are
replaced at the Customer's expense.
· Maintenance required due to failures resulting
from software viruses, wonns, Trojans, and any
other fonns of destructive Or interruptive means
introduced into the System,
· Maintenance required due to failures caused by
Customer facility issues such as inadequate power
sources and protection or use of the System in
environmental conditions outside of those
conditions specified in Identix' System
documentation.
B, Availability of Additional Services. At Customer's
request, Identix may agree to perfonn the excluded
services described immediately above in accordance
with Identix' then current rates. Other excluded
services that may be agreed to be perfonned by Identix
shall require Identix' receipt of a Customer P.O"
Customer's completion of Ideotix' P.O. Waiver fonn,
or Customer providing Identix with a valid credit card
number before work by Identix is commenced,
C. Non-RelZistered Svstem Comoonents, Any System
components not registered in the Addendum for which
Services are requested by Cusromer may be required to
have a pre-maintenance inspection by Identix before
being added to the Addendum and this Agreement,
This inspection will also be required if this Agreement
has expired by more than thirty (30) days. Identix'
inspection will be billed at Identix' current inspection
rate plus travel expenses and parts (if any required),
D, Third Party Hardware and Software. Customer
shall be SOlely responsible for obtaining from Identix
or an Identix authorized or identified vendor, at
Customer's sole expense: (i) all Identix and third party
software that may be required for use in connection
with any Updates, major enhancements or new
versions; and (Ii) all hardware that may be required for
the use of any Updates, major enhancements or new
versions. Ideotix will specify the hardware and third
party software requirements for any Updates,
IV. SERVICE CALLS
3
Nov. 20. 2009 11: 33AM
Customer may contact Identix' TouchCare Support
Center by calling 1-888-HELP-IDX (888-435-7439),
Service calls under this Agreement will be made at the
installation address identified in the Addendum or as
otherwise agreed to in writing.
V. TERM AND TERMINATION
This term of this Agreement shall commence upon
Identix.' receipt of the annual maintenance fee reflected
in the Addendum and shall continue for a period of one
(I) year. This Agreement may be renewed for
additional one (I) year terms upon the parties' mutual
agreement and Customer's execution of an updated
Addendum and Identix' receipt of the applicable
annual maintenance fee reflected in the updated
Addendum, Either party may terminate this
Agreement in the event of a material breach by the
other party that remains uncured for a period of thirty
(30) days from the date the non-breaching party
provided the other with written notice of such breach.
VI. FEES FOR SERVICES
A. Fees. The initial fee for Services under this
Agreement shall be the amount set forth in the
Addendum, The annual maintenance fee during any
renewal term will be Identix' current nites in effect at
the time of renewal. Customer agrees to pay the total
of all charges for Services annually in advance within
thirty (30) days of the date ofIdentix.' invoice for such
charges, Customer understands that alterations,
attachments, specification changes, or use of sub-
standard supplies that cause excessive service calls,
may require an increase in Service fees during the term
of this Agreement at the election of Identix, ftlId
Customer agrees to promptly pay such charges when
due.
B. Failure to Pav Fees. If Customer does not pay
Identix.' fees for Services or parts as provided
hereunder when due: (i) Identix may suspend
perfonnftllce of its obligation to provide Services until
the account is brought current; and (ii) Identix may, at
its discretion, provide the Services at current "non
contracVper call" rates on a COD basis. Customer
agrees to pay Identix' costs and expenses of collection
including the maximum attorneys' fee permitted by
law (said fee not to exceed 25% of the amount due
hereunder).
VII. lJMITED WARRANTY InISCLAIMER I
LIMITATION OF LIABILITY
Version II2007121March2007
No, 6966 p, 9/9
Identix shall provide the Services hereunder in a
professional and workmanlike manner by duly
qualified personnel. EXCEPT FOR TIllS LIMITED
WARRANTY, IDENTIX HEREBY DISCLAIMS
ALL WARRANTIES, EXPRESS AND IMPLIED,
INCLUDING, BUT NOT LIMITED TO, THE
IMPLIED WARRANTIES OF MERCHANTABILITY
AND FITNESS FOR A PARTICULAR PURPOSE IN
REQ.ARD TO THE SERVICES, SOFTWARE, AND
ANY OTHER GOODS PROVIDED HEREUNDER.
IN NO EVENT SHALL IDENTIX' AGGREGATE
LIABILITY TO CUSTOMER ARISING OUT OF, OR
RELATED TO, TIDS AGREEMENT, UNDER ANY
CAUSE OF ACTION OR THEORY OF RECOVERY,
EXCEED THE NET FEES FOR IDENTIX'
SERVICES ACTUALLY PAID BY CUSTOMER TO
IDENTIX UNDER THE APPLICABLE
ADDENDUM TO TIDS AGREEMENT DURING
'!'HE TWELVE (12) MONTHS PRIOR TO THE
DATE THE CUSTOMER'S CAUSE OF ACTION
AROSE. IN NO EVENT SHALL IDENTIX BE
LIABLE TO CDSTOMER FOR ANY INDIRECT,
SPECIAL, INCIDENTIAL, CONSEQUENTIAL OR
PUNITIVE DAMAGES (INCLUDING, BUT NOT
LIMITED TO, LOST PROFITS OR REVENUE;
LOSS, INACCURACY, OR CORRUPTION OF
DATA OR LOSS OR INTERRUPTION OP USE; OR
FOR ANY MAITER' BEYONI;l IDENTIX'
REASONABLY CONTROL, EVEN IF ADVISED OF
THE POSSffilLlTY OF SUCH DAMAGES. NO
ACTION, REGARDLESS OF FORM, MAYBE
BROUGHT BY CUSTOMER MORE THAN TWO
(2) YEARS AFTER THE DATE THE CAUSE OF
ACTION AROSE.
VIII. lJMITED LICENSE TO UPDATES
Identix may deliver Identix-developed Updates to
Customer. The terms of Identix' end user license for
the Identix' software delivered as part of the System
shall govern Customer's use of the Updates.
DL NUSCELLANEOUS
This Agreement shall be governed by and construed
according to the laws of the State of Minnesota,
excluding its conflict of laws provisions. This
Agreement constitutes the entire agreement between
the parties regarding the subject matter described
herein and may not be modified except in writing
signed by duly authorized representatives of Identix
ftlId the Customer. This Agreement may not be
IlSsigned by Customer without the prior express written
consent ofIdentix.
4
,~,
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
CITY RECORD
Page 1 /1
~::W~'\:i18ATELk.<Z~Y
u~R01N8MI3EFFi;311
12/14/2009
09352
VENDOR: 013543
IDENTIX INCORPORATED
5705 WOLD SHAKOPEE ROAD
BLOOMINGTON, MN 55437
SHIP TO: City of Ashland - Police Dept.
1155 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
De~t.:
Contact: Gail RosenberQ
Confirming? No
!.::....{QiJaift~ t;.{Unit\U 2;:~~~'~'i::if~i}~:~~Ta::.!ir:;rr-~,~B'DescHptioHI2'; ';::~~f;~!l::~~;~':';2:[&~1i&.?_:~;Bt~,~~~'~l,i i~i~.'wniiW~1'iEe2f!fiJ ~~ExtrR-rice1r,:~
Annual Maintenance for existinQ
Fingerprinting Machine, Coverage Start
Date: 12/17/2009 End Date: 12/31/2010,
Quote ID: K-3945-S
Machine, Quote ID: K-3945-S,
3,637.59
.
--..
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
3637.59
0.00
0.00
3,637.59
~OUnilNumDe~ _rP.i'OjeCtfNumbe~Jl fii~IAmoun~ ~~-WCcountTNrm16~{M ;~:Wr~'Rroject{Nwiiher~ ~"Amouni1l:.
E 110.06.09.00.60416 3 637.59
/M ~r:':(~t.e
VENDOR COPY
~ORM#10 I
CONTRACT APPROVAL REQUEST FORM
CITY OF
ASHLAND
Total Amount
Contractor/Consultant:
G("Per attached contract.
:5!L" d oJ!~ 't-t ~ L'" e. -
~/?J 0 'I g 5?-
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'l$, ~ 9; ti; 7: <;;;'~
j..:L;___
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H..J.
PUBLIC CONTRACTING REQUIREMENTS - Solicitation Process
0 Exemot from Comoetilive BiddinQ o Invitation to Bid (Copies on file) 0 Emeraencv
Reason for exemption: o Written findings allached
o Quale or Proposal attached
0 Small Procurement & Personal Services D Reouest for Prooosal (Copies on file) CooDerative Procurement
Less than $5.000 Please check one: o Slale of Oregon
Nole: Total conlracl amount, including any o Goods & Services Contract #
amendmenls may nol exceed $6,000 0 Personal Services o Slale of Washington
Intermediate Procurement W Sole Sour~e EX '" -4;":;r . Conlracl #
GOODS & SERVICES o \^intten findings attachedh -i.1 "'.... t:"-/'< o Olher governmenl agency conlracl
$5.000 to $15.000 @/Quole or Proposal attached ffl (;2' ~u';j1..gency
o (31 Written Quoles ('. , Contracl #
PERSONAL SERVICES 0 Soecial Procurement 0 Interagency Conlracl
$5.000 to $50.000 0 Written findings attached Agency
D (3) Written Proposals 0 Quale or Proposal attached Conlract #
Have all public contracting requirements been satisfied?
YES
....-----.
NO
If "NO", City Council approval is required. City Council approval was received on
(Date)
Have funds been budgeted for the purpose of this contract?
YES
..----
NO
If "NO", City Council approval is required. City Council approval was received on
Please provide: Account Number-:: p_ ,tJ.?. LJ -!- - ~''''.,6 _c:.. t ~ f>.:.t!J
Is the amount of the contract less than $25,000? YES v-"
(Date)
NO
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?
(Date)
YES
~
NO
If "NO", City Council approval is required. City Council approval was received on
(Date)
Is the contract for a period of 24-months or less?
YES
~
NO
If "NO", City Council approval is required. City Council approval was received on
(Date)
Please provide terms:
Start date:
Completion date:
Can the contract be terminated for convenience thirty (30) or fewer days
following delivery of written notice to the contractor?
YES
NO
.----'
LJh.... ?-'- g.#,
c::+-z "-<. k.<t0 -r
e.~. 'l;Lc..L.IV""'-".,.;
(Date)~Y"'Y i!"~.
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(...M'~~- l
~1"" >:'1-
c2 t14\- t/oiZ;t C GL.~ ~
If "NO", City Council approval is required. City Council approval was received on
\
COMMENTS:
~~?~ .
~MYcZ~/<.~/~
~ CZ
/':2 - / -cJ q
/
Please circle: ~~) / Not Approved
/~~.
Lee Tunebe~rg L-7q
Date: r ~72cJz;r L
/
Prepared by:
Department:
Date:
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
Date of Request:
12/1(j/09
THIS REQUEST IS A:
o Change Orcler( existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
L _1 Irlpntity ~li Itinnc:
570fi W ()lrl ~h::lknpPA Rrl ~Ilifp. 1 nn
Bloomington MN 555437,1107
(80m 932.lJ890
Pennv Van Lith
SOLICITATION PROCESS
Small Procurement [g] Sole Source 0 Invitation to Sid
[g] Less than $5,000 o Written findings attached (Copies on file)
o Quotes (Optional) o Quote or prorlosal attached
CooDerative Procurement 0 Reauest for Prooosal.
o State of ORlWA contract (Copies on file)
Intennediate Procurement o Other govemmerit agency contract 0 Soeciat I Exemot
o (3) Written Quotes 0 Copy of contract attached 0 Written findings attached
(Copies attached) 0 Quote or pronosal attached
0 Contract # 0 Emeraencv
0 Written findings attached
0 Quote or Prooosal attached
-.
Description of SERVICES
Total Cost
[8J Per attached PROPOSAL Maintenance Agreement 12117/09-12131/1 0 for existing
fingerprint machine
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost,
Project Number _ __ _ __ . ___
o Per attached QUOTE
Account Number 110.06.09.00.604160
. Items and services must be charged to the appropriate account numbers for the financials to rel/ect the actual expenditures accurately.
By signing this requisition fo ,
and the documentation n be
Supervisor/Dept. Head Signature: 7_) ! }0
Employee Signatu .
G: FinanceIPnx:edureIAPlForms\8_Requisifion form revised.doc
Updated on: 12/1012009