HomeMy WebLinkAbout40 - CC-14 - Attachment 4 - 6/16/2015CITY OF COSTA MESA, CALIFORNIA
4L
Purchase Requisition
Vendor ID:
(Leave Blank for Time
Stamp
Purchase Order
Number
(Assigned by Purchasing)
Business Unit: CITY Date Requisitioned: 5/21/15
Department: Development Svs 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
Qty Unit
Items (Give Full Description: Size, Catalog No. Etc.)
Unit Price
Estimated
Amount
1
1 1
Amendment Four Btwn The Cit /The Housing Authority/Keyser Marston &
$ 107,917.00
Associates. Commencing 7/1/15; Ending 6/30/16; Year 3 of 3 Renewals; 3
One Year Options to Renew, Originally Approved 6/12/12 By Council/
Housing Authority. Council Approved Budgets on 05/05/15 and 06/02/15.
See Attached Staff Reports.
If additional lines are needed, please attach a second sheet
Const./Prof. Svs. Agmt. Completion Date: 06/30/16
Insurance Required: ® Yes (Certificate attached ❑ No
Sales Tax (8.00%):
Include Shipping Fee:
Estimated Total Cost:
$ 107,917.00
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
1
750.00
Comments:
Total$ 107,917.00
Additional Funding Sources Included as Part of Grand Total:
#530201-205-11320-20440 $11,917.00 (HOME Admin.)
#530201-207-11310-20427 $ 5,000 (CDBG)
#530201-101-11100-50250 $80,000 (CEO)
Proper approvals are required before requisition can be processed.
Suggested Vendor: Keyser Marston Associates
Address: 160 Pacific Avenue, Suite 204 Ordered By:
City, State, Zip Code: San Francisco, CA 94111
Phone: 415-398-3050 Fax:
Vendor's Contact Person: Diane Chambers X233
Approved By:
Approved By:
Department Director/Authorized Signature
Director of Finance/Purchasing Officer
City Manaqer (when required)
PURCHASING DIVISION USE ONLY
Vendor ID:
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 ❑No
As of:
Confirmed By:
2385-20 MW REV.3/10
Rev FY09/10