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Date 10/21/2016 <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department Public Works <br />Name <br />Richard Estes <br />Division/Bureau <br />Engineering <br />BPW Date <br />10/2512016 <br />Phone Extension <br />5896 <br />I Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Increase <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Required Information <br />HGR Group Inc. <br />❑ Yes ❑ No <br />It Yes, Approved by <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />JMS Exterior Emergency Exit Stairwell <br />116-098 <br />RWDA TIF <br />324-1050-460-3102 <br />$497,097.00 <br />Installation of an exterior emergency exit stairwell. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Change Orders <br />U�0 <br />% <br />py Original <br />® ❑ Patrick C Kerr <br />® ❑ Aaron Kobb <br />® ❑ Matt Douhan (Hebard & Hebard Architects) <br />