HomeMy WebLinkAbout2011-198 Contract - Polydyne Inc Contract for Goods and Services
CITY OF CONTRACTOR: Polydyne, Inc.
ASHLAND CONTACT: Joe DesRochers, Technical Sales Representative
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 250, Riceboro, GA 31323
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 360-931-5566
DATE AGREEMENT PREPARED:07/26/2011 FAX:
BEGINNING DATE: July 1, 2011 COMPLETION DATE: June 30, 2012
COMPENSATION: $1.11 Per Lb delivered - Price confirmation is attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Polymer— Clarifloc C-6286 -will be ordered and delivered as
required by the City of Ashland, Wastewater Treatment Plant.
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.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2798.220, 279B.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;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
Contract for Goods and Services, Page 1 of 5
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
in. 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 j
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 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 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 Liability 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.
C. Automobile Liability 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 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.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
Contract for Goods and Services, Page 2 of 5
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.
Contrac or: City of Ashland
By By iu F, e
Signatureo Department Head
Lawrence D. Grizzle
Print Name Print Name
Business Manager
Title Date
W-9 One copy of a W-9 is to be submitted with roved as to form:
the signed contract. /L
Date q(_✓�7
Purchase Order No.
Contract for Goods and Services, 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:
X (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.
X (2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
X (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.
X' (5) Labor or services are performed for two or more different persons within a period of one
year.
X (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.
J44�— 7/28/2011
Contractor (Date)
Lawrence D. Grizzle, Buisness Manager
Contract for Goods and Services, Page 4 of 5
fj POLYDYNE INC.
PO BOX 250
Riceboro,CA 31323
July 10, 2010
City of Ashland WWTP
ATTN: Mr. Ken Moser
90 N. Mountain Avenue
Ashland, OR 97420
SUBJECT: POLYDYNE CLARIFLOC C-6286 CONTRACT EXTENSION
Dear Mr. Moser:
SNF Polydyne would like to thank you for the continuing business. Thank you for being a long
time customer.
Polydyne, Inc is offering to extend the current agreement for another year up to June 2012 for
Clarifloc C-6286 with a modest price increase from $1.05 to $1.11. As you are aware, cost
increases in raw materials have resulted in a need for higher prices. All raw materials for
manufacturing polyacrylamide originate from the refinement of oil. Raw oil prices have increased
significantly in the past several months. The price increase will take effect June 1, 2011.
Thank you very much for considering Polydyne products for your water treatment needs. If you
have any questions, please do not hesitate to call me at (360) 931-5566.
Sincerely,
Joe DesRochers
Technical Sales Representative
r
.� DATE(M W DDNY)
`��i° CERTIFICATE OF LIABILITY INSURANCE 7A' /27/2011
PRODUCER Phone No. (212)-488-0200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
FRENKEL&COMPANY Fax No. (212)-488-0220 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
350 Hudson Street-4"Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
New York,NY 10014 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC p
INSURED INSURER A: Chants Specialty Insurance Company
INSURERS. National Union Fire Insurance Company of Pittsburgh PA 19445
Polydyne Inc. INSURER C: Hartford RV Insurance Company of Midi 37478
One Chemical Plant Road INSURER D:
PO BOX 250 INSURER e
Riceboro GA 31323 INSURER F:
INSURER G:
INSURER H:
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.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(....,Y y) MWDDIY LIMITS
A X GENERAL LIABILITY EG14362834 12/31/2010 12/31/2011 DAMAGES OCCURRENCE $ 1,000,000
TO
COMMERCIAL GENERAL LIABILITY PREMISES Ea Occurrence $ 500,000
CLAIMS MADE ®OCCUR MED EXP(Any one arson $ 10,000
PERSONAL B ADV INJURY $ 1,000,000
GENERAL AGGREGATE IS 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER'.
PRODUCTS-COMPIOP AGG $ 2,000,000
PRO
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
B X CA3374332 12/31/2010 12/31/2011 (Ea accident)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THAN EACH AC $
AUTO ONLY:
AGO
B X EXCESSNMBRELLA LIABILITY 15972730 12/31/2010 12/3112011 EACH OCCURRENCE $ 1,000,000
OCCUR CLAIMS MADE AGGREGATE IS 1,000,000
DEDUCTIBLE
RETENTION S AT
C WORKERS COMPENSATION AND 1OWNR30600 12/31/2010 12/31/2011 ST
EMPLOYERS'LIABILITY TORYLIMITS ER
ANY PROPRIETGRIPARTNEWEXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000
OFFICERIMEMBER EXCLUDED?
u ❑
yes.dezab M
l,e uer E.L.DISEASE-EA EMPLOYEE $ 1,000,000
SPECIAL PROVISIONS below
E.L.DISEASE POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Ashland is included as Additional Insured under General Liability, Automobile Liability and Excess/Umbrella Liability coverage as
required by contract with respect to liability arising out of the operations of the Named Insured, as their interest may appear, and subject to
the policy terms conditions and exclusions.
RE: Polymer—ClariflocC-6286
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3—DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL
City of Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
90 N. Mountain Avenue REPRESENTATIVES.
Ashland, OR 97420 AUTOO EPRESENTATIVE 1
ACORD 25(2009/01) 19811-2611 AC RD CORPORATION. All Rights Reserved
The ACORD name and logo are register¢ arks of ACORD
SNF • o W41
Contact Sheet
TO: City of Ashland
20 East Main Street
Ashland, OR 97520
Company Name: Polydyne Inc.
Contact: Lawrence D. Grizzle
Phone: (912) 880-2035
Fax: (912) 880-2078
Street Address: 1 Chemical Plant Road, Riceboro, GA 31323
Mailing Address: PO Box 279, Riceboro, GA 31323
Email_p-QjytiAOpj@snfhc.com
Federal Tax ID #: 34-1810283
PAYMENT Remit To Address: PO Box 404642, Atlanta, GA 30384
Payment Terms: Net 30
Customer Service Contact: Ylonda Bailey ext. 632
Phone Number (Toll Free): 1-800-272-3949
Phone Number: (912) 884-3366
Technical Sales Contact: Joe DesRochers
Phone Number: 360-931-5566
Email: jdesrochers @polydyneinc.com
If you have any questions regarding the information provided above please do
not hesitate to contact me at (912) 880-2089. Thank you.
Sincerely,
Jennifer Roberts
Administrative Assistant
P.O.Box 279 • Riceboro,GA 31323 USA • Tel 800-848-7659 • Fax 912-880-2078 www.polydyneinc.com
POLYDYNE INC.
n
PO BOX 250
Riceboro,GA 31323
July 10,2010
City of Ashland W WTP
ATTN: Mr. Ken Moser
90 N. Mountain Avenue
Ashland, OR 97420
SUBJECT: POLYDYNE CLARIFLOC C-6286 CONTRACT EXTENSION
Dear Mr. Moser:
SNF Polydyne would like to thank you for the continuing business. Thank you for being a long
time customer.
Polydyne, Inc is offering to extend the current agreement for another year up to June 2012 for
Clarifloc C-6286 with a modest price increase from $1.05 to $1.11. As you are aware, cost
increases in raw materials have resulted in a need for higher prices. All raw materials for
manufacturing polyacrylamide originate from the refinement of oil. Raw oil prices have increased
significantly in the past several months. The price increase will take effect June 1, 2011.
Thank you very much for considering Polydyne products for your water treatment needs. If you
have any questions, please do not hesitate to call me at(360) 931-5566.
Sincerely,
Joe DesRochers
Technical Sales Representative
C I T Y OF
CITY RECORDER Page 1 /
ASHLAND iP0 NUMBER
20 E MAIN ST. 7/13/2011 10297
ASHLAND, OR 97520
(541)488-5300
VENDOR: 007621 SHIP TO: Ashland WWTP
POLYDYNE, INC. (541) 488-5348
PO BOX 404642 1295 OAK STREET
ATLANTA, GA 30384-4642 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.:
Req. Del.Date: Contact: David Gies
Special Inst: Confirming? NO
`- ti Ou .Unif ,.- , _ P Exescri tlon unt rice t?P.rice
40,000.00 Lb Polymer-Clarifloc C-6286 1.11 44,400.00
Special Procurement
Approved by City Council 07/21/2009
Valid until 06/30/2012
SUBTOTAL 44 400.00
31LL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 44,400.00
ASHLAND, OR 97520
Account Nuin66r., . `ProJectNumber ," _?"I Amount Accoumt Number Project Number : , '_ :'Amount _
E 675.08.19.00.60150 44 400.00
,,e-
Authorized Signature VENDOR COPY
FORM #3 CITY OF
ASHLAND
REQUISITION Date of request:
Required date for delivery:
Vendor Name
Address,City,State,Zip
Contact Name&Telephone Number
Fax Number
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Ememencv
❑ Written Findings(Form attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Note:Total contract amount,including any Dale approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5,000 to$100.000 ❑ Quote or Proposal attached Agency
❑ (3)Written quotes attached Contract#
PERSONAL SERVICES Special Procurement V,7 111-f ❑ Intergovernmental Agreement
$5,000 to$75,000 ❑ Written Findings(Form attached)u� fi Agency
—-O-Less than$35,000,by direct appointment—-❑-Quote or Proposal attached —Contract#
❑ 3 Written proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
--.M14 �i
Ui t'Cl 70'-0
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
U coo 1615 me, /.// /6 �l' %290
❑ Per attached QUOTE zo 4,Nv C r �f✓/O ut'C/ 7 v?/° $'TOTAL COST
L , Q
Project Number • Account Numberl7J.DK/JD--)4' /.SooAccountNumber___-__-_
Account Number - -_ _____- 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,l certify that the information provided above meets the City's public contracting requirements,and the documentation can be provided
upon request.
Employee Signature: Department Head Signature: Mlar, .Q
Additional signatures(if applicable):
Funds appropriated for current fiscal year: / NO 1-111 flll
Finance Director 6�1 Date
Comments:
G:FinancelProcedurelAPTormsWorm#3-Requisitionsoc Updated on:321/2011