HomeMy WebLinkAbout14 - CC-8 - Attachment 2 - 6/2/2015EXHIBIT "B"
PURCHASE REQUISITION -- KMA
CITY OF COSTA MESA, CALIFORNIA
Purchase Requisition
w(Leave
Vendor ID:
Blank for Time
Stam
Purchase order
Number
(Assigned by Purchasing)
Business Unit: CITY Date Requisitioned: 5/20/15
Department: Development Sys Division: HCD
Ship To Address: 77 Fair Drive, 2nd Floor
Contact Person: Silvia Kennerson Phone Number: x5023
Send Copy of P.O. to: ® Contact Person and / or _
® Request is for Budgeted item(s)
❑ Request is for UNBUDGETED item(s)-(Memo Attached)
❑ Item(s) Pending Budget Amendment Request #_
❑ Requesting Sole Source (Justification Form Attached)
❑ Fixed Asset Tag Request
Item
NO
City Unit
Items (Give Full Description: Size, Catalog No. Etc.)
Unit Price
Estimated
Amount
1
1 ; 1
Contract Between Keyser Marston & Associates, The City, and
$ 11,000.00
Costa Mesa Housing Authority, Starting 7/1/15 and
Ending 6/30/16
If additional lines are needed, please attach a second sheet
Const./Prof. Svs. Agmt. Completion Date:
Insurance Required: ® Yes (Certificate attache ❑ No
Sales Tax (8.00%):
Include Shipping Fee:
Estimated Total Cost:
$ 11,000.00
Item #
Account
Fund
Dept./Org.
Program
Project
Amount
1
530201
222
11500
20600
$ 10,000.00
1
530201
222
11500
20650
250.00
1
530201
222
11500
20655
750.00
Comments:
Total$ 11,000.00
Suggested Vendor: Keyser Marston Associates
Address: 160 Pacific Avenue, Suite 204
City, State, Zip Code: San Francisco, CA 94111
Phone: 415-398-3050 Fax:
Vendor's Contact Person: Diane Chambers X233
Proper approvals are required before requisition can be processed.
Ordered By:
Department Director/Authorized Signature
Approved By:
Director of Finance/Purchasing Officer
Approved By:
Cit Mena er when
PURCHASING DIVISION USE ONLY
Vendor ID:
Buyer:
Insurance valid thru
Ship To/Location:
Due Date:
Standard Comments: ACC -ALL-ARR -BLA- CON -DCP- DIS - FCA-FCI- FIX - INS - IS - IST-ORG -QTR- REM - SUB -T&C
FINANCE DEPARTMENT USE ONLY
Available Appropriation: ❑ Yes ❑No
As of:
Confirmed By:
2385-20 MW REV 3110
Rev FY09/10