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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />10/01/2018 <br />Alicia Czarnecki/Kara Bovles <br />Purchasing <br />® Michael Schmidt <br />Department Engineering <br />L] Agreement <br />Lj Contract ❑ Proposal U Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />n Other: <br />Company or Vendor Name Service One Access, Inc. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Morris Theater Emeraencv Plaster Work <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />118-094 <br />Liability Insurance <br />226-0419-672.43-02 <br />$5,700.00 <br />Purpose/Description EmergencyEme[gency work necessa to secure ceilinq of Morris Performing <br />Arts Center and gain occupancy approval after plaster fell from rim <br />of main dome. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Jeff Jarnecke <br />® ❑ Kara Boyles <br />