HomeMy WebLinkAbout15 - CC-8 - Attachment 3 - 6/2/2015EXHIBIT {{C19
PURCHASE REQUISITION
STRADLING YOCCA CARLSON & RAUTH
r,I` yT-M�s, .,,.
CITY OF COSTA MESA, CALIFORNIA
VendorlD:
Purchase Order
Purchase Requisition
w(Leave
Insurance valid thru
Ship To/Location:
Number
I Due Date:
Standard Comments: ACC-ALL-ARR -BLA
- CON -DCP- DIS - FCA -FCI- FIX- INS - IS - IST -ORG -QTR- REM - SUB -T&C
(Assigned by Purchasing)
Available Appropriation: ❑ Yes ONO
Blank for Time
As of:
Confirmed By:
Stamp
Business Unit: CITY Date Requisitioned: 5/20/15
® Request is for Budgeted items)
Department: Development Svs Division: HCD
❑ Request is for UNBUDGETED item($) -(Memo Attached)
Ship To Address: 77 Fair Drive, 2nd Floor
❑ Item(s) Pending Budget Amendment Request #_
Contact Person: Silvia Kennerson Phone Number: X5023
❑ Requesting Sole Source (Justification Form Attached)
Send Copy of P.O. to: ® Contact Person and / or _
❑ Fixed Asset Tag Request
Item
City Unit
Items (Give Full Description: Size, Catalog No. Etc.)
Unit Price
Estimated
Amount
1
1 1
Annual Contract Between The City, The Housing
Authority, and
$
Stradlin /Yucca/Carlson & Ruth; Starting 07/01/15 Ending 06/30/16
If additional lines are needed, please attach a second sheet
Sales Tax (8.00%):
Const./Prof. Svs. Agmt, Completion Date:
Include Shipping Fee:
$ 52,000.00
Insurance Require ® Yes Certificate attache ❑ No
Estimated Total Cost:
Item #
Account
Fund
Dept./Org.
Program
Project
Amount
1
530300
222
11500
20600
$12,000.00
1
530300
222
11500
20620
15,000.00
1
530300
222
11500
20625
5,000.00
Comments:
Total$ 52,000.00
Additional Funding Sources:
530300-222-11500-20630 $5,000.00
530300-222-11500-20635 $15,000.00
Suggested Vendor: Stradling Yocca Carlson & Rauth
Address: 660 Newport Center Drive Suite 1600
City, State, Zip Code: Newport Beach, CA 92660
Proper approvals are required before requisition can be processed.
Ordered By:
Department Director/Authorized Signature
Phone: 949-725-4141 Fax: 949-843-5141 Approved By:
Vendor's Contact Person: Celeste Brady
Approved By:
Director of Finance/Purchasing
PURCHASING DIVISION USE ONLY
VendorlD:
Buyer:
Insurance valid thru
Ship To/Location:
I 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 ONO
As of:
Confirmed By:
2385-20 MW REV.3/10
Rev FYI 2/13