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HomeMy WebLinkAbout2012-021 Contract - Kottke Plumbing Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Kottke Plumbing Inc. ASHLAND CONTACT: Darren Chase 20 East Main Street Ashland, Oregon 97520 ADDRESS: 2820 Foothill Blvd, Grants Pass, OR 97526 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-664-6044, 541-778-3454 DATE AGREEMENT PREPARED:January 30, 2012 FAX: BEGINNING DATE: January 31, 2012 COMPLETION DATE: March 22, 2012 COMPENSATION: $6,477.22 — Per proposal attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Contractor to remove old plumbing and complete installation of new plumbing and fixtures, includes saw cutting and replacement of concrete, per the plans and proposal attached as Exhibit C. Location: Mountain View Cemetery 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$18,890 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: Contract for Goods and Services Less than $25,000, Revised 06/30/2011, 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. 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 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 chan e. There shall be no cancellation, material change, reduction of limits or Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 2 of 5 intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s)to the Oity. 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. Contr ctor shall sign the certification attached hereto as Exhibit A and herein inco rated by refer Contra or: City o Ashla B B nature a rt ��RI✓t CNA� a� iis�� . Print Name Pri tName Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. ` l0 Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 3 of 5 EXHIBIT A 1 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) 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 Less than$25,000, Revised 06/30/2011, Page 4 of 5 JAN-24-2012 09:44A FROM:KOTTKE PLUMBING 5416645417 TO:5415522304 `` -- P.1 ! B ,2 KOT°TKE PLUMBING POI' OSW Po Bo=937 (sdl)664 6044 Medford,OR 1/23/2012 97501 Proposal For: Job Site: CITY OF ASHLAND CITY OF ASHLAND 20 EAST MAIN STREET 440 Normal Street ASHLAND,OR 97520 Ashland,OR 97520 Specifications my Rate Total proposal to complete plumbing remodel to Include plumbing for the fbIlowing fixtums.1 handicapp usikt, 1 3,360.00 3,360.00 wall hung Inv, 1 roll in handicapp shower unit, I kitchen sink, I dishwasher connections,1 refifdgavor ice box, 1 washing machloo reeassed boot.1 laundry free standing unit, ISO gal electric water homer.This portion of bid Is for rough plumbing and installation of fixtures only. Saw cutting end demo.include replace of concrete. "� 1,350.00 Option ro upgrade Rani heater ro 80 gal chute S d �X 76 7, Fixture list as provided,see suachod list permit fees not included in bid / pro prix Bid does rrot include ryf/ 3, .00 3,I replacement of sewer line or water service piping. Y_ 25%deposit to start,50%upon rough plumbing,balance upon final.Fixture list will he billed fbr separate 0.00 0.00 from this contract. I / 1p Iv . V i Total s� Payment Terms & Conditions All material is guarw teed to meet spceifketian All work to be aompkurd in a professiaml.workmanlike manner,according to standard practices. Any altamlan I%or deviation fforn the above specifications involving extra costs will he escci only upon written orders,and will be billed as an extra charge ovor and above this estimate. If asbestos is suspected,toning and any and all resulting more will be over and above this proposal amount If during excavation.we mounter rode,debris,rock or concrete that requires the use of s jockhammer or other heavy equipment the excavation will be m time and material over and above the proposal amotrmt All agreements are contingent upon strikes,accidents, or delays beyond our control. Owner to carry Ore and o0xr accessory insurance. Workers are fully covered by worknm's compensation insurance. Signing this farm affirms warrantee any poly pipe repels or customer supplied materials. Note:This proposal may be withdrawn if not weepled within 30 Days Acceptance no above proposed prim specifications,and temp 6 conditions am sal.sfoctory and hereby accepted. Y with rizcd w com 1 tc this ork as specified. Payment will be made as Indicated above. Signature / Signature Date Date 5�// ;7,ze 3S/ S`� FEB-8-2012 02:09P FROM:KDTTKE PLUMBING 5416645417 TO:541 4 P 1 KOTTKE PLUMBING 1 Estimate 3646 CALHOUN RD MEDFORD, OR 97501 Date Estimate 0 CCB#106021 V1/1012 207 Name f Address CITY OF ASHLAND 90 N Mountion Rd ASHLAND.OR 97520 Project 440 Norms!Strcct Description Qty Cost Total Bradford White electric water heater 1 305.55 305.55 Grab bars 1 106.25 106.25 Dayton Self rimming stainless steel sink 1 202.06 202.06 Delta 400-DST kitchen faucet with spray 1 95.78 95.78 ISE Badger 5 1/2 HP garbage disposal 1 97.41 I Fiber Fab shower unit with sent and gmb bars I 1,483.88 1,483.81 Delta 1748 Shower vale and trim kit i 133.00 r 135.00 Hand held shower and slide bar I 148.34 Kohler wall hung Inv sink I 60.55 60.55 Delta Inv faucet I . 165.97 165.')3 ADA Wntcr closet with left hand trip lever I 256.64 256.64 Bemis 1955C wnter closet seat,open front less cover I 20.37 20.37 Pro Flo mop sink I 77.43 77.43 American Standard mop foueel 1 34.81 34.81 Total $3,190.00 Customer Signature ADDENDUM TO CITY OF ASHLAND CONTRACT FOR GOODS AND SERVICES LESS THAN $25,000 Addendum made this 8`h day of February , 2012, between the City of Ashland ("City") and Kottke Plumbinq, Inc. ("Contractor"). Recitals: A. On January 30, 2011-, City and Contractor entered into a "City of Ashland Contract for Goods and Services Less than $25,000" (further referred to in this addendum as 'the agreement'). B. The parties desire to amend the agreement to modify the scone of services and increase the compensation to be paid to Contractor. City and Contractor agree to amend the agreement in the following manner: 1. The scope of services is being modified to include the additional work required by State of Oregon Building Code and City of Ashland Building Inspector at a cost of $755.00 per proposal attached Exhibit A. 2. Except as modified above the terms of the agreement shall remain in full force and effect. CONT C OR: CIT OF AND: B i✓- ii. Its tisl s Date n ea DATE Purchase Order# Acct. No.: � a -7e x12 (For City purposes only) 1-CITY OF ASHLAND,ADDENDUM TO CONTRACT FOR GOODS AND SERVICES KQTTKE PLUMBING Proposal Po Box 937 Medford, OR (541)664 6044 2/1/2012 97501 Proposal For: Job Site: CITY OF ASHLAND CITY OF ASHLAND 20 EAST MAIN STREET 440 Normal Street ASHLAND, OR 97520 Ashland, OR 97520 Specifications Qty Rate Total Change Order: To add Floor drain in garage area,added concrete cutting and removal,added replacement of 0.00 0.00 concrete,added plumbing parts and labor. Concrete cutting,removal,and replacement. 285.00 285.00 Additional labor to excavate and plumb. 3 85.00 255.00 Additional parts.Trap primer,Floor drain,abs pipe and fittings,trap primer discharge. 215.00 215.00 This change order to be billed separate from contract proposal. Total $755.00 Payment Terms & Conditions All material is guaranteed to meet specifications. All work to be completed in a professional,workman like manner,according to standard practices. Any alteration to,or deviation from the above specifications involving extra costs will be executed only upon written orders,and will be billed as an extra charge over and above this estimate. If asbestos is suspected,testing and any and all resulting costs will be over and above this proposal amount. If during excavation,we encounter roots,debris,rock or concrete that requires the use of ajackhammer or other heavy equipment,the excavation will be at time and material over and above the proposal amount.All agreements are contingent upon strikes,accidents, or delays beyond our control. Owner to carry fire and other necessary insurance. Workers are fully covered by workmen's compensation insurance. Signing this form affirms warrantee any poly pipe repairs or customer supplied materials. Note:This proposal may be withdrawn if not accepted within 30 Days Acceptance The above proposed prices,specifications,and terms&conditions are satisfactory and hereby accepted. You out orized to co plet this work as specified. Payment will be made as indicated above. Signature Si e Date Date Fax sent by : 5414885851 ASHLAND INSURANCE BZ-88-1Z 88:59 Pg: 1/1 CERTIFICATE OF LIABILITY INSURANCE GATE(MYmOMryy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER./ HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ExTENn OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BE LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUOIG INSURER(S), AUTHORIZED REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE MOLDER IMPORTANT: N the cortiflc o folder M an ADDITIONAL INSURED,lire polley(ies)must be endorsed. q SUBROGATION IS WANED,sub ecl to the terms and Co In lie na of such Polley,certain polNlies may requlm an endOTSemmnL A Statement on this Certificate does not Confer rights to the certificate holdw In lieu of such erMOrsama s, PRODUCER Julie Aahar Ashland InauranCO Inc PHONe (5e1)482-0831 F 585 A Street Suite 1 .ISalua-yew P. O. Box 860 :jaehetQ aehlandineurance.oom Ashland OR 97520 Usv AFFORDING COVERAGE NAK:d INSURED g"WM101RE"RA:O1r Eagle plumbing NOrthweet Inc, F Co ration DBA: Kottke Dlumbing 3646 Calhoun R,d.Medford OR 97501 COVERAGES CERTIFICATE NL MBEFR:C1,11l020O32S3 REVISION NUMBER: I THIS IS TO CERTIFY THAT THE PONY RE OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TNt 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 O ISSUES OR SUCH PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUDJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE UCY EFF GENERALL MELM POLCYNUMBSR Mlp MI UNITS X COMMERCIAL GENERAL LIAELITY EACI I OCCUHREW:F S 1,000,000 A X CIAWS.MADC OCCUR 912091 1/1/2011 1/1/2012 Ee Arnv,c S 100,000 MEO FAP one Pwmn f 10,000 PERS0AAL L AN INJURY S 1,000,000 GENEWLL AGGREGATE S 2,000,000 G[NL AGIREGATE LIMIT APPLIES PER; X PO ICY PRO LOC PNODUCTS-COMPgP AGG f Ine is AUTOMOBILE LNBRITY f NED I LE LIM X ANYAUTO Ea... ^I 1 000 000 A ALL OVAIED SCHEDULED BODILY INJURY(Pwa .,l S AUTOS LJ N S 912091 1/1/2011 1/1/2012 BODILY INJURY(per a,ddPa S NIREOAVTOS AUTOS PRI OAMIAGE f UMBRELLA We OCCUR %Ndkx 1, f 5 000 EACEIRI CLAIMS.MADS CACH OCCMAEMCE : LIED RETENTION AGGREGATE S B WORKERS COMPENSATION F AND EMPLOYEW LIABILITY YIN INC 6IATU- 0 ANY PNOPMETORIPARTIJER4DISCUrIYE �OFFICERMEMWR IMLUOLU7 NIA E.LEACHACCIOFNT S 1 000 000 Mandeb H NH I ws aunA,a 77287 /1/2031 /1/2012 LL OISEASF EA EMPLOYE f 1 000 000 UESCRIPr1ON OPEMMONS DMor EL DISEASE-POLICY WSn S 1 000 000 DESCR1PnONCFOPEMT10N "OMTRIN91YEM"03(AUach ACORD101,Ackjd IRS,vIn SeINdNS.it PparP a mquinMl) CERTIFICATE HOLDER CANCELLATION (541)552-2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EMRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Dale 20 E. Main St. AUTHORIZED REPRE9E71TA7NE Ashland, OR 97520 Julie Ashes ACORD 2S(2010/05) •2010 ACORD CORD INS025(20t0mpt ORATION. All rights reserved. The 4(Y1RD names.ndl IMn are iar.:.Fer�I...,a,,.�AY•naan Page 1 1 KATY MCCOWER / �. CITY OF ASHLAND DATE PO NUMBER 20 E MAIN ST. 2/1312012 10673 ASHLAND, OR 97520 (541)488-5300 VENDOR: 001843 SHIP TO: Ashland Building Maintenance KOTTKE PLUMBING (541)488-5358 P O BOX 937 90 N MOUNTAIN AVENUE MEDFORD, OR 97501 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del.Date: _ contact: Dale Peters Special Inst: Confirming? NO Des'cription' ;:',Umt Pride,- &t.P,rice,. Plumbing -Temporary Fire Station#2 6,477.22 Per attached proposal and contract Contract for Goods &Services Beginning date: January 31, 2012 Completion date: March 22, 2012 Insurance required/On file Additional work required per State of 755.00 Oregon Building Codes and City Building Inspector. Per attached Contract Addendum dated February 8, 2012. SUBTOTAL 7,232.22 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 7,232.22 ASHLAND, OR 97520 Account'Number, .' %'ProjectNumber .> :, Amount ,;'Account Numbed Project Number, ;"' -Amount ? . E 410.08.24.00.704200 E 000278.120 7,232.22 Auth riled Signature VENDOR COPY FORM #3 CITY OF ASHLAND r REQUISITION Date of request: z9 1.9�1z Required date for delivery: ASIA Vendor Name 18T7-K� t i^-b'.- q TNc Address,City,State,Zip Contact Name&Telephone Number M t p , a2 ©2 975-0) Fax Number SOLICITATION PROCESS ❑ Exempt from Competitive Bidding ❑ Emergency ❑ 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) ❑ Stale of Oregon Note:Total contract amount,including any Date approved by Council: Contract# amendments may not exceed$6,000 ❑ Stale 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 ❑ Intergovernmental Agreement $5,000 to$75,000 ❑ Written Findings(Form attached) Agency ❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract# ❑ 3 Written proposals attached I Date approved by Council: Date approved by Council: Description of SERVICES I Total Cost L c`moVrrwI �' e e 1 \� ��. o' rt�o eo.. Fe �' / '`7. �1J STrqu- b4Trea ry oT Ne:W �)Lw�b� `^� IAND �iX��A /Q�@� /(!I' INCA-c4pr=S Sww C.A�.�v.q p ,.�v R.C���r9e.E..•e.+� OT ev�,M2E $fir -�—�-- Y tX.� ,�. Item # Quantity Unit J Description of MATERIALS Unit Price Total Cost .' "-,"i arc `L TOTAL COST ❑ Per attached QUOTE •'��-2—�—� $ Project Number_ Z-'2$ JZ_0 Account Number g10-fa$ 2-1.M- O`}2OOAccountNumber___-_--__-------------------- 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,I 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: Additional signatures(if applicable): Funds appropriated for current fiscal year: �Y&l NO t10 ✓} Z r��Layi Finance Director Date, Comments: G FinanceTrocedurOAPTormsTorm#3-Requisition.doc Updated on:1/18/2012