HomeMy WebLinkAbout04 - CC-4 - Attachment 2 - 12/1/2015ATTACHMENT 2
CITY OF COSTA MESA CALIFORNIA
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Purchase Requisition
Vendor ID:
(Leave Blank for Time
Stamp)
Purchase Order
Number
(Assigned by Purchasing)
Business Unit: CITY Date Requisitioned: 12/01/15
Department: Development Sys Division: Planning
Ship To Address: 77 Fair Dr., 2"a Floor, Casta Mesa, CA
Contact Person: Silvia Kennerson Phone Number: x5023
Send Copy of P.O. to: ® Contact Person and 1 or
® Request is for Budgeted item(s)
❑ Request is for UNBUDGETED item(s)-(,demo Attached)
❑ Item(s) Pending Budget Amendment Request 4
❑ Requesting Sole Source (Justification Form Attached)
❑ Fixed Asset Tag Request
Item
Qty Unit
Items (Give Full Description: Size, Catalog No. Etc.)
Unit Price
Estimated
Amount
1
1
Initial PSA with Lilley Planning Group and the City
of Costa Mesa
$ 93,000.00
7 Months, Starting December 2015 Ending June 30, 2016
with Two One Year Options to Renew
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:
$ 93,000.00
Item #
Account
Fund Dept./Org.
Program
Project
Amount
1
530201
101 18200
20320
$ 93,000.00
Comments:
Total$ 93,000.00
Ray Pascua's Email Address: ray@ldleyplanning.com
Proper approvals are required before requisition can be processed.
Suggested Vendor: Lilley Planning Group„
Address: 564 S. Brea Blvd. Ordered By:
City, State, Zip Code: Brea, CA 92821
Phone: 714-672-9906 Fax: None
Vendor's Contact Person: Rav Pascua
Approved By:
Department Director/Authorized Signature
Director of Finance/Purchasing Officer
Approved By:
Rih, 6Aa n.— (wha —Ar,d)
PURCHASING DIVISICIN USE ONLY
Vendor ID:
Buyer:
Insurance valid thru
Ship To/Location:
I Due bate:
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.3l10