Res 1410 - Purchase Agmt St OR
COUNCIL BILL NO. 1792
RESOLUTION NO. 1410
A RESOLUTION AUTHORIZING AN AGREEMENT WITH THE STATE OF OREGON
DEPARTMENT OF GENERAL SERVICES FOR PURCHASING.
WHEREAS, the City has in the past contracted with the State of Oregon
Department of General Services to enable the City to take advantage of State
purchasing services, and
WHEREAS, it is in the interests of the City to formalize said agreement
and continue said agreement, NOW THEREFORE,
THE CITY OF WOODBURN RESOLVES AS FOLLOWS:
Section 1. That the Mayor is authorized to sign on behalf of the City the
1997-98 Cooperative Purchasing Agreement with the State of Oregon, General
Services Division.
Section 2. That said agreement is attached hereto and, by this reference
incorporated herein. ~/v'\ ^ ~ C _ '72-1'1-
Approved as to form: ~ ..:> L--
City Attorney Date
APPROVED:
NANCY A.
Passed by the Council
May 27, 1997
Submitted to the Mayor
May 28. 1997
Approved by the Mayor
May 28, 1997
Filed in the Office of the Recorder
May 28, 1997
ATTEST: fY\~~
Mary Tenna , City Recorder
City of Woodburn, Oregon
Page 1 -
COUNCIL BILL NO 1792
RESOLUTION NO. 1410
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)REGON COOPERATIVE PURCHASING PROGRAM (ORCPP)
1.0 DEFINITIONS:
1 .1 Agency Specific Contract: Requirements Contract bid by State for a specified
Public Agency.
1.2 Agreement: This Oregon Cooperative Purchasing Program subscription
agreement for Qualified Agencies, as defined in Section 2.0 of this document.
1.3 Budget: A plan of financial operation embodying an estimate of expenditures for
a given period or purpose and the proposed means of financing the estimated
expenditures. ORS 294.305 (4).
1.4 Contract: Written agreement, including the State Solicitation Document and the
accepted portion of a bid or proposal, document between State and contractor,
describing the work to be done and the obligations of the parties. OAR 137-30-
000 (7) and 125-30-000 (10).
1.5 Electronic Advertisement: Placing ITB, RFP, RFI, or RFQ Solicitation
Documents or nqtices on the Vendor Information Program (VIP) system.
1.6 Invitation to Bid (ITB): Solicitation of competitive, written, signed and sealed bids
in which specification, price and delivery (or project completion) are the.
predominant award criteria. OAR 125-30-000(27}.
1.7 Notice of Order: See Purchase Document.
1.8 ORCPP: Acronym for the State of Oregon Cooperative Purchasing Program.
1.9 PCRB: Acronym for Public Contract Review Board.
1 .1 0 Purchase Document: Qualified Agency's official contract document used to
purchase product or services. (e.g., purchase order)
1.11 Purchase Request: Document requesting the purchase of product or service,
includes specification and requirement for product or service and contains the
signature of an authorized representative from requesting Qualified Agency.
1.12 Qualified Agency: Organization that has met the minimum ORCPP qualification
as defined in ORS 190.003, 190.110(1), 190.240,279.855(1) through (3) and has
an active ORCPP agreement on file with State.
1.13 Requirements Contract: An agreement in which the contractor agrees to supply
some or all of the agency's requirements that arise for an item or items during a
specified time period. OAR 125-30-000(49}
1.14 Request for Information (RFI): A document used to solicit information on
industry standards, practices, and delivery methods. The document does not
request pricing and makes it clear that the RFI is only seeking comments and
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information. (As defined by the National Institute of Governmental Purchasing
(NIGP) "Public Purchasing and Materials Management" manual.
1.15 Request for Proposal (RFP): The solicitation of written, competitive proposals,
or offers, to be used as a basis for making an acquisition, or entering into a
contract when specification and price will not necessarily be the predominant
award criteria. OAR 125-30-000(48). .
1.16 Request for Quote (RFQ): The soliciting of offers from competing bidders. The
solicitation may be accomplished by initiating a request to vendors to make an
otter. The solicitation and the offer may be in writing or oral. OAR 125-30-000(7).
1.17 Resale: Selling products purchased from State contract(s) to an other party.
1.18 Restricted Contract: Contract having participation restriction(s), requiring special
stipulations to be met prior to use of Contract.
1.19 Single Purchase Contract: A Contract developed for a one time purchase of an
item(s), requiring the contractor to hold pricing firm for a predetermined period of
time. Typically 60 days from the time of bid opening or longer if stated in the
Contract.
1.20 Solicitation Document: ITS, RFP or RFQ which includes all documents,
(attached or incorporated by reference) utilized for soliciting bids or proposals.
OAR 137-30-000(25)
1.21 State: The Department of Administrative Services, Transportation, Purchasing
and Print Services Division, Purchasing Section.
1.22 State Agency: Every state officer, board, commission, department, institution,
branch or agency of the state governments, whose costs are paid wholly or in part
from funds held in the State Treasury.
1.23 Statewide Contract: Requirements Contract developed for use by state
agencies, as defined in ORS 279.710(2), ~d Qualified Agencies.
1.24 Vehicle: Automobile or motorized equipment used for transport or operated by a
driver.
1.25 Vendor Information Program (VIP): State of Oregon's electronic information
program used to access and publicize government bidding opportunities, state
Contract information, vendor detail and directories for Oregon, Minority, Women
and Emerging Small Business and participating ORCPP agencies.
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OREGON COOPERATIVE PURCHASING PROGRAM
2.0 PROGRAM QUALIFICATIONS
There are four (4) ways in which an organization can qualify to participate in the Oregon
Cooperative Purchasing Program (ORCPP). Your organization must meet one of the
following qualifications. Please indicate in the'space provided the qualification that best
describes your organization.
Submit, with a signed ORCPP Agreement, any requested documentation
supporting your organization qualification. The State reserves the riQht to require
requestinq aqency to secure leQal opinion - describinq and/or substantiatinq
aqency's qualifications.
2.1 L A unit of local government having separate autonomy
such as Oregon counties, cities, municipalities or other public
corporate entities having local governing authority. A United States
governmental agency or American Indian tribe or agency, excluding
State Agency as defined in section 1.22 of this document.
2.2 Qualified non-profit agency for disabled individuals participating in
the program set forth in ORS 279.820 to 279.850.
Note: Qualified non-profit organization/agency must be certified as a Qualified
Rehabilitation Facility with the Department of Administrative Services Purchasing Unit's
Special Programs Coordinator. Contact the Special Programs Coordinator, (503) 373-
7125, for information regarding certification.
2.3 Residential program under contract with the Department of Human
Resource (DHR) or a division thereof to provide services to youth in
the custody of the state.
Note: Submit with the ORCPP Agreement a letter from Department of Human
Resources (DHR) or d!vision thereof verifying the residential program's contract with.
DHR. The letter must be on DHR or DHR division letterhead and contain the
following information:
· Scope of contract, what service is being provided.
· Contract number
· Starting and expiration dates of contract
· State Contract Administrator's, name, original signature, mailing address and
telephone number
2.4 Public benefit corporation aas defined in ORS 65.001 that provides
public services either under contract with a state agency, a~ defined in
ORS 171.133, or under contract with a unit of local government, as
defined in ORS 190.003, that funds the contract, in whole or in part
with state funds.a You must meet all four reauirements listed to aualify under
this section. Submit substantiating documentation that supports the public benefit
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corporation meets each of the following four parts. Note: State will review
substantiating documentation prior to participation approval.
1. Active status Domestic, Nonprofit Corporation that is:
a. Formed as a public benefit corporation pursuant to ORS 65.044 to 65.067;
b. Designed as a public benefit corporation designated by statute;
c. Recognized as tax exempt under section 501 (c) (3) of the Internal Revenue
Code of 1986 or
d. Otherwise organized' for public or charitable purpose in accordance with itls
articles of incorporation and bylaws;
2. Organization is restricted so that on dissolution it must distribute its assets
to:
a. An organization organized for a public or charitable purpose;
b. A religious corporation;
c. The United States of America;
d. A state of the United States of America, Q.(
e. A person who is recognized as exempt under section 501 (c) (3) of the
Internal Revenue Code of 1986;
Note: The organization's articles of incorporation should contain this information.
3. IS NOT a Itreligious corporation" as defined in ORS 65.001 (33).
Note: The organizations' articles of incorporation should contain this information.
4. Organization under contract with a state agency, -as defined in ORS
171.133, or under contract with a unit of local government, as defined in
ORS 190.003, that funds the contract, in whole or in part with state funds."
Note: Provide a letter from the state or local government agency confirming your
contract with them. The letter must be on the state or local agency's letter head and
contain the following information:
. Scope of contract (what service is being provided)
. Contract number
. Starting and expiration dates of contract
. Confirmation that the contract is funded by state funds in part or in
whole
· Signature, name, mailing address & telephone number of the state or
local government contract administrator
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iEGON COOPERATIVE PURCHASING PROGRAM (ORCPP)
3.0 STANDARD ORCPP AGREEMENT SERVICES
Pursuant to ORS 190.110, 190.210, 190.240, relating to intergovernmental and
interstate agreements. The Department of Administrative Services, Purchasing Section
(UStateU) hereby agrees to provide cooperative governmental purchasing services to:
the City of Woodburn
("Qualified AgencyH) as defined in section 1.12 of this agreement, in accordance with
the terms and conditions of the following Cooperative Purchasing Agreement
("Agreement") .
3.1. Purchases from Statewide Contracts: The State, in contracting for the
purchase of goods and services according to statutes and rules governing
purchasing by and on behalf of the State of Oregon, agrees to permit Qualified
Agency to purchase from Statewide Contracts.
Qualified Agency:
a) Agrees not to use Statewide Contract{s) to leverage or secure
better or equal pricing from competing vendor(s).
b) Is responsible for complying 'with Qualified Agencys laws and
regulations and any additional laws and regulations governing
purchases by Qualified Agency. _
c) May purchase from Statewide Contract{s) using Qualified Agency's
Purchasing Document to the awarded contractor. The followina
statement shall be on each Purchase Document issued for product
or service from a Statewide Contract: .
IITHIS PURCHASE IS PLACED AGAINST STATE OF
OREGON SOUCITATlON OR CONTRACT #
THE TERMS AND CONDITIONS (TIS & CiS) OF SAID
SOUCITATlON OR CONTRACT APPLY TO THIS PURCHASE
AND TAKE PRECEDENCE OVER ALL OTHER Tis & CiS
WRITTEN OR IMPUED".
d) Reserves the right to contract independently for the purchase of
any class of goods or services, without notice being given to
State.
e) Shall not use a Statewide Contract unless the Contract expressly
states that ORCPP members are authorized to use the Contract.
f) Agrees to comply with all special stipulations when purchasing -
from restricted Statewide Contracts. (e.g., Vehicle Contracts).
g) Agrees that all purchases from Statewide Contracts will be made
.only for the direct use of the Qualified Agency. Qualified Agency
shall not purchase on behalf of any third party or for resale. .
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3.2 Attachment to Other Procurements: The State solicits for Agency Specific an<...
Single Purchase Contracts. Many of the Agency Specific and Single Purchase
Contracts include language that will allow ORCPP participants to purchase off of
the Contract. Purchases may be made within a specified number of days after the
bid closing date or award, or throughout the Contract term.
3.2.1 Agency Specific Contracts
Qualified Agency may make purchases off of such Agency Specific Contracts
provided that Qualified Agency:
a) Requests State to add Qualified Agency as a purchaser under Agency
Specific Contract{s).
b) Receives written authorization from State to purchase from the
particular Agency Specific Contract(s).
c) Is responsible for complying with any additional laws and regulations
governing purchases by or on behalf of the Qualified Agency
91 May purchase from Agency Specific Contract(s) using Qualified
Agency's Purchase Document to the awarded contractor. The
followinq statement shall be on each Purchase Document issued for
product or service from Aqencv Specific Contracts:
"THIS PURCHASE IS PLACED AGAINST STATE OF
OREGON SOUCITATION OR CONTRACT #
THE TERMS AND CONDITIONS (TIs & CiS) OF SAID
SOUCITATlON OR CONTRACT APPLY TO THIS PURCHASE
AND TAKE PRECEDENCE OVER ALL OTHER T's & CiS
WRITTEN OR IMPUED".
e) Agrees that all purchases from Agency Specific Contracts will be made
only for the direct use of the Qualified Agency. Qualified Agency shall not
purchase on behalf o.f any third party or for resale.
3.2.2 Single Purchase Contracts. From time to time, State enters into Single
Purchase Contracts for the benefrt of state agencies. State reserves the right to
determine in its sole and absolute discretion whether to add Qualified Agency to Single
Purchase Contract(s). State may authorize Qualified Agency to purchase off of Single
Purchase Contract(s) provided that:
Qualified Agency:
a) Requests State to add Qualified Agency to Single Purchase Contract(s).
The State will work with the Contractor to determine if the addition may be
made.
b) Shall submit a Purchase Request to State prior to the end of the
contractor-s requirement to hold pricing firm and within reasonable time
(e.g., 48 hours) for State to process a purchase order.
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c) Shall provide State a list of agents authorized to submit Purchase Request.
List shall include agents name and copy of their signature.
(See item 11.0 of this Agreement)
Request for purchase shall be for product as specified in State Solicitation Document
and shall contain the following infonnation to ensure timely processing:
. Qualified Agency name . Description of product(s)
. Agency number (number assigned . Quantity and unit
by ORCPP) . Unit price
. Ship to address . Total Price
. Bill to address . Ordered by name and signature
. Contract number (4 digit State If) . Ordered by telephone number
. Date wanted . Approved person'~ name
. Number of invoices and signature
. Accounting information (optional) . Approved person's telephone
number
3.3 Vehicle Purchases: State develops Statewide Contracts and Single Purchase
Contracts for a variety of vehicles each model year. Qualified Agency may make
Vehicle Purchases off of such contracts provided that the Qualified Agency meets
the requirements of Sections 3.1 and 3.2 and the Qualified Agency complies with
the following additional provisions:
Qualified Agency:
a) Shall reference the vehicle (base unit) item number from the State
Contract on the Notice of Order.
b) Agrees to send a copy of the Notice of Order to State at:
Fleet Buyer
Department of Administrative Services
TPPS, Purchasing Section
Ferry Street SE
Salem, OR 973.10
3.4 Electronic Bid and Quote Solicitations: The State's VIP system electronically
displays ITB(s), RFP{s) and RFQ Solicitation Documents and advertisement
notices. This provides vendors global access to Solicitation Documents.
Documents may be viewed/received electronically by vendors.
Qualified Agency:
a) Has authority to use the VIP system as a vehicle to transfer (upload) their
ITB, RFP and RFQ Solicitation Documents and advertisement notices.
b) Shall take full and complete responsibility for the content and substance, as
well as the grammatical and textual quality, of all Solicitation Documents
uploaded and displayed on the VIP system.
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3.5 Standard ORCPP Service Fees: State is not funded by the General Fund and
must recover the cost of providing and administering the services.
Qualified Agency:
a) Agrees to pay to the State a non-refundable Annual Agreement fee upon
subscription to ORCPP services. The Annual Aareement fee covers the
cost of services identified in sections 3.1. 3.2 and 3.4.
b) Agrees to pay any additional fee incurred as part of this Agreement.
3.5.1 Agreement Fee Structure:
a) The fee structure is based on the Qualified Agency's total organizational
Budget.
IMPORTANT: Please initial, in the space provided below, the Budget range that
represents your organization's annual budget.
Annual Fee Schedule
f
Organizational Budget
Subscription
Fee
MORE than
$ 0.00
$ 3,000,000.00
$ 7,500,000.00
$ 21,000,000.00
$ 30,000,000.00
$ 68,000,000.00
$ 90,000,000.00
$ 150,000,000.00
LESS than or e ual to
$ 3,000,000.00
$ 7,500,000.00
$ 21,000,000.00
$ 30 000 000.00
$ 68 000 000.00
$ 90,000,000.00
$ 150,000,000.00
$ 200.00
$ 500.00
$ 900.00
$ 1,000.00
$ 2,000.00
$ 3,000.00
$ 4,000.00
$ 5,000.00
b) Qualified Agency shall submit approved budget documentation.
c) State reserves the right to verify Qualified Agency's organizational
, . budget.
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5.2 Vehicle Purchases:
State:
a) Shall bill and Qualified Agency shall pay a non-refundable $75
administrative fee for each vehicle purchased from Statewide Contract or
from a Single Purchase Contract. Administrative fee will be billed at time of
order notice.
b) Reserves the right to verify Qualified Agency's copy of the Notice to Order to
those provided to State by the contracted vendor.
c) Qualified Agency shall pay $200 for each vehicle - in addition to the $75
administrative fee for failure to notify State of Qualified Agency's vehicle
Notice to Order.
4.0 ADDITIONAL ORCPP AGREEMENT SERVICES:
4.1 Solicitation Services. On mutual agreement between Qualified Agency and State,
State purchasing analysts may prepare Solicitation Documents (ITS's or RFP's) on
behalf of Qualified Agency. Solicitation Document(s) development shall be drafted
according to the public purchasing statutes and rules for state aquisitions. If
Qualified Agency's jurisdiction has unique requirements, State's purchasing
analysts will not be able to address those factors. Solicitation services are not
available for products and\or trade services on existing Statewide Contracts.
State:
a) Shall notify Qualified Agency upon acceptance of Purchase Request.
b) State analyst shall provide Qualified Agency a time and cost estimate for the
completion of the solicitation process, prior to Solicitation Document
development.
c) Shall draft Solicitation Document(s) on the State's automated purchasing
system for the Qualified agency,
d) Shall advertise the Solicitation Document(s) on the State's VIP system,
e) Shall assist and recommend the solicitation process on behalf of Qualified
Agency.
f) Shall assist Qualified Agency so that Qualified Agency can determine
responsive bidder for contract award.
g) Shall assist Qualified Agency with issuing contract to awarded vendor(s).
h) State reserves the right to not provide solicitation services.
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Qualified Agency:
-
a) Shall submit to State a Purchase Request containing the following
information:
. Qualified Agency name
. Agency number (number assigned
by ORCPP)
. Ship to address
. Bill to address
. Contract number (4 digit State #)
. Date wanted
. Number of invoices
. Accounting information (optional)
.
.
.
.
.
.
.
Description of product(s)
Quantity and unit
Unit price
Total Price
Ordered by name and signature
Ordered by telephone number
Approved person's name
and signature
Approved person's telephone
number
.
b) Shall assist State to determine responsive bidder for apparent award of
contract.
c) Shall acquire PCRB approval as appropriate; e.g.; for sole source or brand
name awards.
d) Shall be responsible for inspection of goods, supervision of trade services
contractors, and compliance with or enforcement of manufacturer or
contractor warranties and other related matters following award of contract.
e) Understands that State will assess a separate service fee for solicitation
services.
f) Qualified agency shall be responsible for any and all protest resolution.
4.2 Reciprocal Cooperative Agreements: The State may enter into interstate
cooperative purchasing agreement(s). Interstate cooperative purchasing
agreement(s) may contain reciprocal language to allow Qualified Agency to use a
portion or all the defined purchasing services provided by either state.
State:
a) Shall notify Qualified Agency of available interstate cooperative purchasing
agreement(s).
b) Shall outline for Qualified Agency the purchasing service available, procedures
for use, and additional cost(s) if applicable when using the interstate
agreement(s).
Qualified Agency:
a) Is responsible for complying with Qualified Agency's laws and regulations and
any additional laws and regulations governing purchases by Qualified Agency,
including PCRB approvals.
b) Agrees not to use pricing on contract(s) available through the interstate
cooperative purchasing agreement to leverage or secure better or equal pricing
from competing vendor(s).
c) Reserves the right to contract independently for the purchase of any class of
goods or services, without notice being given to State or host state of interstate
agreement.
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d) Shall not use a contract(s) available through the interstate agreement unless
the contract(s) expressly states that ORCPP members are authorized to use
the contract.
e) Agrees to comply with all special stipulations when purchasing from interstate
contracts.
f) Agrees that all purchases from contract(s) available through the interstate
agreement will be made only for the direct use of the Qualified Agency.
. Qualified Agency shall not purchase on behalf of any third party or for resale.
4.3 Additional ORCPP Services Fees:
Solicitation Service Fees: Qualified Agency understands that by submitting a Purchase
Request to State that there are fee associated and Qualified Agency shall pay:
a) A fee of $100, for up to two hours of review, and $25 per hour thereafter for
the State to review Qualified Agency's Purchase Request for completeness
prior to State acceptance of the Purchase Request. If State accepts the
project this fee shall be applied to ,the base fee referenced below.
b) Base fee is $500, or $25 dollars per hour, which ever is greatest.
c) Fees for solicitation services, as described in section 4.1, will be billed and
collected on an as-used basis.
d) Legal fees associated with solicitation development, award, protest, etc., are
the sole responsibility of Qualified Agency.
5.0 Agreement Term: The ORCPP Agreement, is effective as of the date signed by the
State, and shall remain in effect until June 30, of succeeding year.
6.0 Agreement Renewal:
State:
a) Shall send Qualified Agency a notice for ORCPP Agreement renewal 60 days
prior to Agreement expiration 9ate.
Qualified Agency:
a)
Shall submit to State the ORCPP Agreement annual subscription fee and
renewal documentation prior to or during the renewal period of July 1, to July 31
of each year.
,. ...,.,J>.'..
b)
Understands that Qualified Agency's use of ORCPP Agreement services during
the renewal period, July 1 to July 31, shall be deemed a renewal of Qualified
Agency's ORCPP Agreement. State shall bill Qualified Agency for ORCPP
Agreement annual subscription fee and any other charges related to service( s) if
renewal is not received before July 31.
7.0 Termination: This Agreement may be terminated by either State or Qualified Agency
upon 30 days' written notice. No such termination shall prejudice any rights or
obligations of either party already accrued prior to the effective date of termination. Any
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and all fees paid to State are non-refundable including, without limitation, the ann\..
subscription fee, restricted contract use fee and an additional service fee.
8.0 Hold Harmless, Indemnity: Subject to any constitutional limitations, Qualified Agency
shall defend, hold harmless and indemnify State, its divisions, officers, employees,
agents and members from all claims, suits, or actions of whatsoever nature resulting
from or arising out of the acts or omissions of Qualified Agency, or its officers,
employees, agents or subcontractors, under this Agreement.
9.0 Successors in Interest, Assignment: The provisions of this Agreement shall be
binding upon and inure to the benefit of the parties hereto and their respective
successors and assigns. Neither party shall assign or transfer its interest in this
Agreement without the prior written consent of the other.
1 0.0 Limitation of Liability: Qualified Agency understands and agrees that the State makes
no representation or warranty regarding the suitability, durability, merchantability or
fitness for a particular purpose of any goods or services available through this
Agreement. Qualified Agency agrees that the State shall not be subject to any claims,
actions, or liability arising out of or in any way related to any defect, malfunction, or
damage of any nature arising from or related to goods or services obtained from
contractors through this Agreement. Further, the State shall not be liable for any direct,
indirect, incidental or consequential damages sustained by Qualified Agency and arising
out of or in any way related to goods or services obtained from contractors through this
Agreement.
11.0 Authorized Agents: Qualified Agency agrees to (i) provide State a list of all persons
authorized to sign Purchase Requests on behalf of the Qualified Agency, including
samples of such persons. signatures, and (ii) immediately infonn State of any change in
authorized agents.
Sig*n:t~~~O S{!ATJtl~TURE
Name: CHRIS CHILDS
Title:
CITY ADMINISTRATOR
SHEET
Signature:
Name:BEN GIJ,T.F.f:PTF.
Title: F I NANCE
KENNETH ~
POLICE CHIEF
Signature: .~ ~ _
Name: G. S. I WAR I
PUBLIC WORKS DIRECTOR
Title:
Title:
12.0 Applicable Law, Venue: This Agreement shall be governed by and construed in
accordance with the laws of the State of Oregon. Qualified Agency agrees to comply
with all laws, rules and ordinances applicable to this Agreement, including but not limitea
to, ORS 279.312, 279.314,279.316 and 279.320. In the event of any litigation between
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the State and Qualified Agency arising out of or related to this Agreement, such litigatio
shall only be commenced and maintained in the Circuit Court of Marion County in Salem,
Oregon. .
13.0 Signatures: Each party, by the signature of its authorized representative, hereby
acknowledges that it has read this Agreement, understands it, and agrees to be bound
by its terms and conditions. Each person signing this Agreement represents and
warrants to. have the authority necessary to execute this Agreement.
QUALIFIED AGENCY
APPROVED AS TO FORM:
QUALIFIED AGENCY
Signature:"#~~~
Name: NANCY A KIRKSFY
Title: HAYOR, CITY OF WOOD URN
Date: May 28. 1997
,<') "dNt/'.,
Signature: ' I.~-y \f (~v_---...---J. _
Name: N Rob~ if S~ i ~ tJ-l
Title: C "i q -tIoliVt J
Date: G - 3> - 1:f-
********************************************************************************************************
STATE
STATE OF OREGON
APPROVED AS TO FORM:
Signature:
Name:
Title:
Date:
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