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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/15/2017 <br />Name Patrick Sherman <br />Department VPA: Facilities & <br />Grounds <br />BPW Date 12/21/2017 Phone Extension 5601 <br />Regui 1-d Prior to Submittal to Board <br />Legal Attorney Name <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />E Michael Schmidt <br />❑ Agreement <br />❑ Contract M Proposal L_J Addendum <br />F-1 Professional Services <br />Resolution <br />F-1 <br />Bid Opening <br />E] <br />Bid Award F-1 Req, to Advertise ❑ Title Sheet <br />[] <br />Quote Opening <br />Q Quote Award <br />F-1 <br />Change Order No. <br />n C/O & PCA No. F-1 PCA <br />F-1 Ease/Encroach. <br />❑ Traffic Control <br />n Other: <br />Company or Vendor Name Culligan Water <br />New Vendor [:] Yes Z No If Yes, Approved Iby Purchasing <br />MBE/WBE Contractor ❑ MBE [:] WBE <br />MBE/WBE Contractor Requested E] No 0I Yes Name of Company <br />Project Name Morris Performing Arts Center: Water Softener Sys <br />Project Number 1028-2017 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />K1 MPAC <br />416-0404-453-36.01 <br />$ TBD <br />no <br />H <br />Request for Proposals to provide commercial water softening <br />system for the Morris Performinq Arts Center. <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, INon-Debarment, E-Verify, Iran, etc,' <br />Amount of F-1 increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change,: % <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />F] <br />El <br />El <br />