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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /16/2018 <br />Name Alicia Czarnecki/Kara Boyles Department Engineering <br />. ._.. _... <br />BPW Date 11/27/2018 Phone Extension 5903 <br />��� E =M <br />m._ <br />Reuired Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />Quote Opening <br />Change Order No. _ <br />j Ease/Encroach. <br />[� Other: <br />aro riate Item Tye'! <br />El Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />fo. ........... <br />I Proposal El Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />paired Information <br />Company or Vendor Name American Structureooint, Inc. <br />❑ PCA <br />New Vendor <br />I❑ Yes E <br />No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Morris Theater Emergency Plaster Work <br />.......1...1..8._09.4......................................�............................... <br />ProjectNumber <br />Funding Source <br />.................................._.._....... _.._....__.......................... ................... <br />VPA Morris <br />Account No. <br />226-0419-672.36-01 <br />Amount <br />$7,750.00 <br />Terms of Contract <br />N_TE <br />Purpose/Description <br />_ <br />�Consulting engineering services to determine options for remedial <br />repairs to the decorative plaster in the Morris Theater, <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non-Debarment,E-Verify, Iran, etc. <br />I egg fired For Change Orders Onl r <br />Amount of Increase $ <br />E] Decrease $ <br />Previous Amount $................... <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy Original <br />® ❑ Jeff Jarnecke <br />® ❑ Kara Boyles. <br />Dispersal After Approval <br />