HomeMy WebLinkAboutbocc.con.044.2011CLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR SCANNING/ARCffiVING
corrTRacT #: �w-a� l I
ORIGINATING DEPARTMENT/DIVISION: Fleet
CONTACT PERSON: James Gilliam PHONE #: 920-5765
PROJECT NAME: Broom Bristle
❑ BOCC AGENDA ITEM �STAFF AUTHORIZED SIGNATURE
(Requires I30CC Signature) (per Revised Procurement Code 7/2005)
❑ Over �g0,000 (Requires County Manager's Signature)
✓ CHECK PROCUREMENT TYPE:
❑None �Informal ❑Formal ❑Sole Source ❑Emergency ❑State Bid ❑
❑Compliance with House Bills 06-1343 and 07-1073 — Immigration Form (Under $10,00Q Letters of Engagement, etc
�DOLLARAMOUNT: $43,544.16
✓ CHECK CONTRACT TYPE:
❑ Services/Mai ntenance
❑License/Use
❑Lease
❑Construction
�Goods, Equipment, Supplies
❑Other (e.g. revenue)
BUDGET LINE IT�M/LEDGER NUMBER: 505.52 00000 83754
❑Employment (for county employees)
❑Intergovemmental Agreement (Reyuires BOCC Action)
❑Non-Profit
❑Quasi-Public
❑Grant Agreements (Reyuires BOCC Action)
❑Change Order/Contract Amendment
CONTRACTOR: United Rotary Brush COMPLETE LEGAL OF NAME OF BUSINESS (if different from
contractor)
Contract Execution Date:
Automatic Renewal: ❑Yes ❑No
S �O
Contract End Date:
Term of Contract:
All Contracts hould be r f d i th f ll
p oo e or e o owing.
✓ ,�-�! o Pages Missing
✓ vi a Page is Left Intentionally Blank —Note on Page
✓ �ge numbered consecutively
✓ [_ y 411 Signatures Affixed
✓ DAll Dates Filled In
✓ DAII Other Blanks Filled In
✓ nAll Exhibits Attached
,�
1 � �.
-� � ,
✓❑HB 06-1343 and 07-1073 (Immigration Legislation) Included in RFP and/or Contract
✓ ❑All Legal Descriptions Attached (if applicable)
✓❑Notice of Award/Notice to Proceed Attached (if applicable)
✓ ❑Warranty (if applicable)
✓❑Special Instructions for Finance Department: Paid with P-Card
✓ ❑Sentto Clerk and Recorderfor Scanning/Archiving
✓❑Authorized Staff Person's Name: James Gilliam
Bl' CHECKING ABOVE AND ENT�RING NAME, THE AUTHORIZED STAFF PERSON INDICATES THAT
THE ATTACHED DOCUMENT HAS BEEN PROOFED AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHNES RETAINAGE SCHEDULE.
ivz�no�s
INFORMALPROCUREMENT
MEMORANDUM
TO: File
FROM: James Gilliam
RE: $10,Q00 to $44,494 Purchase Form
n4B Broom Bristle sets
DATE: Februazy 22, 2011
Description of Purchase: Broom Bristles For MB Brooms
Budget: as needed
Contractors Contacted: United Rotary Brush, Phone
O. J. Watson email
Mylisk Inc email
Proposals Received: United Rotary Brush $725736 set
O.J. Watson $10,579.63 set
Myslik Inc no response.
Firms chosen: United Rotary Brush
Chosen for lowest price.
,�- .� - � � - �a/ 1
A t rized Signer Date
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* For sole source. emerQencv nrocurement or state bid. use designated forms on the m/drive
under "Other procurement " instead of this form.
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www. united
FEDERAL E.I.N 48-0945667
Pitki� County Airport
T6 Service CeMer Rd
Aspen, CO 87611
I CUSTQMERID
116037
I SALES REPID
97
I qunr��rr
I ORO � SHP 1 8CK
6 6 0
East Location
20078 State Route 4
Marysville, Ohio 43040
937-644-3515
800-851-5108
Fax: 937
West Location
160 Enterpnse Ct- Ste A
Galt, CA 95632-8795
209-744-4200
800-851-5108
Fax: 209-7A4-2904
Central Location
15607 West 1�Oth Terrace
Lenexa, KS 66219
913-888-8450
800-851-5108
Fax:913-541-8310
EPD
20078 State Route 4
Marysville, Ohio 43040
800-896-0003
Fax:937-642-3552
fNVO10E
Remit to:
United Rotary Brush
20078 State Route 4
Marysville, OH 43040
Invoice ID: C1115229
Da1B:3/70/2017
Order No: Co10824a
Page No: 1
F.O. B: PPD/OE
Soid To Ship Ta
Pitkin County Airport
1U01 Owl Creek Rd.
Aspen, CO 81617
CUSTOAAER PO �� PAYMENT 7ERMS
JAMES I Credit Card
SHIPPING AAETHOD t PRO NUMB£R / TRAGKING NUMBER
SEST WAY
PART
DESCRIPTION
29-CW235280 TUFTED WIRE CASSETTE REFILL
Refer to packlist number: PACK127222
I
IT
�X
$7,257.36
ORDER SPECIFiCAT10NS
CALL 970-920-5760 EXT 0, JAMES GILLIAM, WHEN AT GATE TO BE LET IN, AIRPORT GATE 11.
CC APPROVED MW
C018577
SUB TOTAL;
TOTAL AMOUNT DUE:
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Ca'��
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EXiENDED
PRICE
$43, 544.16
$43,544.16
$43, 544.16
USD
PLEASE INSPECT PROMPTLY. Claims for Credit or Adjustments must be made within 10 days after receipt of shipment.
No return accepted without UNITED ROTARY BRUSH return material authorization number.
FR£IGHT TERMS �
PPD/OE 1
SHIP DATE - I INYOICE DUE DATEI
3/10/2011 � 3/17/2011 �
UNIT
PRICE
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