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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />fiNFLIGIM11R] <br />Kvle Silveus <br />Department rr�eerin <br />BPW Date 11/13/2018 Phone Extension 9083 <br />in anwi .. a�mm��ww�r�re��m�mmwrurweu�r�rr��u�u�n�rm�u�w�i� evevmev��rv�rroirrr�naanvrmmweur.,gr . _. :�rrn�zrr. � uHUHUHUHmHumwu�imi�i�m�uuwuwuwu�uauwiuirc�.�.�. .::."— ,� ,�.. pis <br />,d..—. �......, .................. <br />.. ......... .. <br />...� N�quired Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller El 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 F] <br />Check the <br />H Agreement <br />® Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />Change Order No. _ <br />El Ease/Encroach. <br />F-1 Other: <br />Michael Schmidt <br />iro riate Item T e — <br />....-_i? w...._ _ --- yL -- <br />Contract <br />IL^l Resolution <br />d for All Submissions <br />Proposal <br />Bid Award ❑ Req. to Advertise <br />El Quote Award <br />C/O & PCA No. ❑ PCA <br />Traffic Control <br />Required Information <br />Company or Vendor Name Forum Architects LLC <br />New Vendor E] Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor LJ MBE' WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name O'Brien Recreation Center Renovation .......... <br />Project Number 1....8._..9 <br />.................-.-_.............._..._..._.��_�.......................... <br />FundingSource South <br />uth Side Development Area <br />Account No. 430-1050-460.42-02 <br />Amount.....� 33,75.�._..�.�_...........................................w�__ � ��,..................�.�............................................... <br />Terms of Contract Lump Sum <br />Addendum <br />❑ Title Sheet <br />Purpose/Description Renovation <br />Required Contractor's Certification Form Attached (Non- <br />mmm _mmmm __........._ Collusion Non -Discrimination, Non -Debarment. E-Verify, Iran, etc. <br />Required For 'C ar e Orders Onl <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 <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />