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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/21/2024 <br />Name Patrick Sherman Department Public Works <br />BPW Date 03/26/2024 Phone Extension 5601 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />® Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Mickey Lovy <br />Michael Schmidt <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ® Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name M/E Design Services <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Project Name Studebaker Museum HVAC <br />Project Number 124-020 <br />Funding Source PO-0030281 <br />Account No. 324-10-102-121-443001--PROJ00000524 <br />Amount $9,300.00 <br />Terms of Contract EJCDC Amendment <br />Purpose/Description Design services quoting out two or more HVAC units at the Studebaker <br />Museum. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />