HomeMy WebLinkAbout2011-194 Contract - Univar USA Inc Contract for Goods and Services
CITY OF CONTRACTOR: Univar USA44nc.
ASHLAND CONTACT: Shawnasey McCarthy
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 8201 S. 21 e, Kent, WA 98032
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 253-872-5000
DATE AGREEMENT PREPARED:06/30/2011 FAX: 253-872-5041
BEGINNING DATE: July 1, 2011 COMPLETION DATE: June 30, 2011
COMPENSATION:
WTP—Cytec Superfloc C-573 Flocculant ($1.271/Lb, Del charge $95.00 per order, Min 4 drums per order)
WTP—C tec Su erfloc N-300 LMW Flocculant $2.70/Lb Del charge $95.00 per order, Min 6 bas per order
GOODS AND SERVICES TO BE PROVIDED: WTP Chemicals as specified and resulting from Invitation to Bid
2011-101. Contract approved by City Council June 21 2011.
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 specked 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.
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, 2798.225, 2798.230, 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$18,703 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. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
I. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services:
Contract for Goods and Services, Page 1 of 5
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. Obligation/Liability 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.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 466A.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 shalt 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 under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work 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.
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 Liablli �e with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,00 ,. 1,000,000 2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall inc actual liability coverage for the indemnity provided under this contract.
C. A m it rance with a combined single limit, or the equivalent, of not less than Enter one:
$200;000,$500,000, 11000,00 r Not Applicable for each accident for Bodily Injury an rmage,
including coverage for hired or non-owned vehicles, as applicable.
d. Notice of cancellation or change. 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.
Contract for Goods and Services,Page 2 of 5
i
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 Council or 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
rn�/�/Yt�/ � City of Ashland
By Q " " ' 4 By - .D Q1_
Signature Department Head
Print Name Print Name
Perry ICu6ak.t,bG
Title Date
W-9 One copy of a W-9 is to be submitted with r ved as to form:
the signed contract �n q
Purchase Order No. / ��
Contract for Goods and Services,Page 3 of 5
I . .
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:
_ (1) 1 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— (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) 1 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.
Contractor (Date)
Contract for Goods and Services, Page 4 of 5
C I T Y OF
June 30, 2011 ASHLAND
Shawnasey McCarthy
Univar USA, Inc.
8201 S. 212 '
Kent, WA 98032
Dear Shawnasey:
Thank you for submitting your bid to the City for WTP & WWTP chemicals.. Your
company is being awarded a public contract for two of the chemicals required for
use at the Water Treatment Plant.
I have enclosed the contract for the two WTP chemicals. The contract requires
that Certificates of Insurance be provided to the City for General Liability,
Business Automobile and Workers' Compensation, including the City of Ashland
as the additional insured. For more information regarding the insurance
requirements, please see section 16 on page 2 of the contract.
Please return the signed contract and insurance certificates to my attention at the
following address:
Karl Olson
Purchasing Representative
City of Ashland
90 N. Mountain Avenue
Ashland, Oregon, 97520.
If you have any questions or need additional information, I can be reached at
(541) 488-5354.
Thank you.
Sincerely,
Kai Olson
Purchasing Representative
PURCHASING Tel:541-488-5354
City of Ashland Fax:541.4885320 ��,
90 N. Mountain TTY;541-5521234
Ashland,Oregon 97520 I/t
www.ashland.or.us
-�i QQ1{enfl•Conwm. [onuni
�� ® DATE(MM/DDIYYYYI
CERTIFICATE OF LIABILITY INSURANCE D],BB B,1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. 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). �
ER
CONTACT O
ADD Rion Rsk Services central, Inc. NAME:IPHO.N -7122 INC.No.): -5390
Philadelphia PA Office AICNO.E.q: (866) 283 (84]) 953 d
y
One Liberty Place E-MAIL p
1650 Market Street ADDRESS: _
suite 1000
Philadelphia PA 19103 USA INSURERIS)AFFORDING COVERAGE NAIC 0
INSURED INSURER A: Chartis Specialty Insurance Company 26883
UNIVAR USA INC INSURER B: National union Fire Ins Co of Pittsburgh 19445
17425 NE union Hill Road
Redmond WA 98052-3375 USA INSURER C: Illinois National Insurance Co 23817
INSURER O: Insurance Company of the State of PA 19429
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:570043222010 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
INSR
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYY MMRUdYTYY LIMITS
a GENERAL LIABILITY GL EACHOCCURRENCE 53,000,000
% COMMERCIALGENERALLIABILITY SIR applies per policy terns & Condi ions AMA ETORENTED
PREMISES Ea occurrence) (300'000
CLAIMS-MADE X❑OCCUR MED EXP ymy one person) $10,000
% SIR:$2,000,000 PERSONAL 6 ADV INJURY $3,000,000
GENERAL AGGREGATE $3,000,000
N
GEN'L AGGREGATE LIMITAPPLIES PER'. PRODUCTS-COMP/OP AGG $3,000,000 rN'e
X POLICY PRO- LOG o
• AUTOMOBILE LIABILITY CA 4806890 03/01/2011 0 /0l 2012 COMBINED SINGLE LIMIT $5,000,000 E es
- Truckers Liability (A05) a accident ..
• X ANYAUTO CA 4806891 03/01/2011 03/01/2012 BODILY INJURY(Per person) O
ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY(Per accident) O
• AUTOS AUTOS CA 4806892 03/01/2011 0310112012 q
NON-OWNED PROPERTY DAMAGE O
HIRED AUTOS pUTOS Truckers Liability (VA) Per accident
Y
m
UMBRELLA LIPH OCCUR EACH OCCURRENCE D
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION
D WORKERS COMPENSATION AND WC 01591220 03/01/2011 03/01/2012 X I WC STATU OTH-
EMPLOYERS'LIABILITY YIN ADS TORYLIMITS I IER
ANY PROPRIETORIPAATNERIEXECUTIVE E.L EACH ACCIDENT $1,000,000
oFFICEWMEMBER EXCLUDED' NIA SIR applies per policy terns & condT Tons
(Mandate,in NH) EL DISEASE-EA EMPLOYEE 51,000,000
u as 4eecnca order —
DESCRIPTIONOFOPERATIONSBeIOw E.I.DISEASE-POLICY LIMIT $1,000,000._3l
�i
DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
RE: Contract to Supply water Treatment Chemicals, Ashland, City of waste water Treatment Plant.
Eq
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City Of Ashland AUTHORVED REPRESENTATIVE
Attn: Kari Olson
90 N. Mountain Road
Ashland OR 97520 USA �/, i%UdC cJ�tnrard �O p �i
spy 01988-2010 ACORD CORPORATION.AN rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Attachment to ACORD Certificate for UNIVAR USA INC
'I he terms.conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s).This attachment does not contain all terns.conditions.coverages or exclusions contained in the policy.
INSURER
INSORED
UNIVAR USA INC INSURER
17425 NE Union Hill Road
Redmond WA 98052-3375 USA INSURER
INSURER
INSURER
ADDI'T'IONAL POLICIES Ifa policy below does not include limit infomlation.refer to the corresponding policy on the ACORD
certificate boon for policy limits.
INSR ADDL SIIBR 1'OLICI'NUMBER] POLICI'EFF POLICY ENP
LTR II PE Or INSURANCE INSR II'VD P(ILICI DESCRIPTION 6H.NIDDII'1'1'1'
IaI BIIDDl1')'1'11 LIMITS
AUTOMOBILE LIABILITY
B CA 4806893 3/01/201 03/01/2012 combined 55,000,000
Commercial Auto (A05) Single Limo
B CA 4806894 3/01/201 03/01/2012
Commercial Auto (NA)
B CA 4806895 3/01/201 03/01/2012
commercial Auto (VA)
WORKERS COMPENSATION
B N/A wc1591222 3/01/201 03/01/2012
CA, OH, OR & WA
SIR applies per policy terms & condit ons
(_ N/A W0001591223 3/01/201 03/01/2012
WI
SIR applies per policy terms & condit ons
D N/A wc001591221 3/01/201 03/01/2012
FL
SIR applies per policy terms & condit ons
C N/A W0001591224 UT7917=777n7=
Tx
SIR applies per policy to ms & condit ons
Certificate No: 570043222010
Page 1 / 1
C I T Y OF 61TY RECORD
�S H LAN t DATE'':.1' PO NUMBER .
t*671 20 E MAIN ST. 7/6/2011 10275
ASHLAND, OR 97520
(541)488-5300
VENDOR: 000191 SHIP To: Ashland Water Treatment Plant
UNIVAR USA INC, ACCT#146175 (541)488-5345
FILE#56019 ASHLAND, OR 97520
LOS ANGELES, CA 90074
FOB Point: Req.No.:
Terms: Net 30 days Dept.:
Req.Del.Date: contact: Greg Hunter
Special Inst: Confirming? No
lJni£ DescH •tion unit
4.00 Ordr Invitation to Bid#2011-101 987.86 3,951.44
CYTEC SUPERFLOC N-300 LMW FLOCCULANT
4 Orders
6 Bags per order
$2.70/Lb
Delivery charge$95.00 per order
Minimum 6 bags per order
7.00 Ordr CYTEC SUPERFLOC C-573 FLOCCULANT 2,637.00 18,459.00
7 Orders
4 Drums per order
$1.271/Lb
Delivery charge$95.00 per order
Minimum 4 drums per order
SUBTOTAL 22 410.44
3ILL TO:Account Payable TAX A02:9009 20 EAST MAIN ST FREIGHT 541-552-2028 TOTAL 22,4
ASHLAND, OR 97520
I ' Account Number ' " 'Project Number ;+ '" Am6u66`. Account Number „ i Project Number, Amount.`
E 670.08.19.00.601500 22 410.44
AuthotMed Signatute VENDOR COPY
CITY OF
ASHLAND
REQUISITION FORM
Date of Request:
THIS REQUEST IS A:
❑ Change Order(existing PO# ) Required Date of Delivery/Service:
Vendor Name U N NA R
Address,City,State,Zip
Contact Name&Telephone Number
Fax Number
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding 1 1 - i o 1 ❑ Emeraencv
Reason for exemption: Invitation to Bid (Copies on file) ❑ Wrillen findings attached
Date approved by Council: ' El Quote or Proposal attached
El Small Procurement&Personal Services Cooperative Procurement
Less than$5,00 ❑ Reauest for Proposal (Copies on file) ❑ State of Oregon
Note:Total contract amount,including any Date approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written findings attached ❑ Other government agency contract
$5,000 to$100.000 ❑ Quote or Proposal attached Agency
❑ (3)Written quotes attached Contract#
PERSONAL SERVICES ❑ Special Procurement ❑ Intergovernmental Agreement
$5.000 to$75.00 ❑ Wrilten findings attached Agency
❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract#
❑ 3 Wdtten proposals attached Date approve by Council: Date approved by Council:
Description of SERVICES Total Cost
13l-AM KrT PURCHASE, aRDCR FOR '7 - 1 - t1 To
6 -3o -12 , WATER TREA-TMI_N1 GHrMICALS
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
9 OKPERs 6 (3rr��0 c u
s /oCX er- 00 -Pow _300 87. 86 3951 .` 4
2 oRDE 5 1)c Ntr,s 2K C-S 73 FloCGU�ctin� 2 37,`'° 18459. 110
❑ Per attached QUOTE TOTAL COST
$224 I Ai
Project Number---------- Account Number--_----_ - ----_-- AccountNumber0o.A.19 -Oo -6oISo0
- -- --- -- -- -- -
-----
AccountNumber------- _- -_--_-- Account Number _
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed.
By signing this requisition form,I certify that the information provided above meets the City's public contracting requirements,and the documentation can be provided
upon request.
Employee Signature: C Department Head Signature: Q
Additional signatures(if applicable):
Funds appropriated for current fiscal year.- NO 72111,
Finance Director Date
Comments:
G:FinancelProcedurelAPlFormslForm#3-Requisition,doc Updated on:7122010