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130ARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/16/2018 <br />Name Patrick Sherman <br />Department VPA: Facilities & <br />Grounds <br />BPW Date 01/23/2018 Phone Extension 5601 <br />Legal <br />Attorney Name Clara McDaniels <br />Controller <br />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 />Michael Schmidt <br />Ghopckth, <br />e APP <br />ropriateltem Typq— Required,torAll',Subm�issions, <br />M Agreement <br />El Contract El Proposal El Addendum <br />F-1 Professional Services <br />F-1 Resolution <br />Bid Opening <br />F-1 Bid Award ❑ Req. to Advertise El Title Sheet <br />Quote Opening <br />F-1 Quote Award <br />F-1 Change Order No. <br />F-1 C/O & PCA No. n PCA <br />n Ease/Encroach. <br />❑ Traffic Control <br />F1 Other: <br />Company or Vendor Name Culligan Water <br />New Vendor F1 Yes M No El IIf Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE F-1 WBE <br />MBENVBE Contractor Requested ❑ No I❑ Yes Name of Company <br />Project Name Morris Performing Arts Center: Water Softener System <br />Project Number 1028-20,17 <br />Funding Source _K1MPAC <br />Account No. 416-0404-453-36.01 <br />Amount $10,405.00 <br />Terms of Contract Lump Sum <br />Purpose/Description Agreement to provide commercial water softening system for the <br />Morris Performing Arts Center to firm chosen through RFP. <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, N on-Di:scriurination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of LJ Increase <br />E] Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />F-1 <br />F-1 <br />1-1 <br />D <br />El <br />R <br />Dispersal After Approval <br />