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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/01 /2018 <br />Name <br />Alicia Czarnecki/Kara Boyles <br />Department <br />Engineering <br />BPW Date <br />10/09/2018 <br />Phone Extension <br />5903 <br />Required Prior to Submitfial to Board <br />Legal ® Attorney Name Clara McDaniels <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 />® Michael Schmidt <br />Agreement <br />"Contract L_J 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 />❑ Change Order No. <br />❑ <br />C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />f l <br />Other: <br />Company or Vendor Name American Structurepoint, Inc. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Morris Theater Emergency Plaster Work <br />Project Number 118-094 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of 0 <br />...... _........ ....... <br />Liability Insurance <br />226-0419-672.43-02 <br />$8,900.00 <br />Emergency work necessary to secure ceiling 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-Verify, Iran, etc.) <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />❑ <br />Jeff Jarnecke <br />Kara Bovles <br />% <br />Dispersal After Approval <br />