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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 08/08/2019 <br />Department VPA: Facilities & <br />Name Patrick Sherman <br />Grounds <br />BPW Date 08/13/2019 <br />�m WroaN��NN���N��W����00000��a000 <br />��oro�a�o Phone Extension 5601 <br />Re <br />....____________� <br />uired Prior to Submittal to Board <br />Legal <br />........................._................._.. _....__.......... ww <br />Attorney Clara McDaniels <br />Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller <br />and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Michael Schmidt <br />Check the A ro <br />riate Item T y p­_e_—,_,R""e u,ired for All Submissions <br />Agreement <br />Contract E] Proposal F] Addendum <br />❑ Professional Services <br />Resolution <br />Bid Opening <br />E] Bid Award I❑ Req. to Advertise ❑ Title Sheet <br />EJ Quote Opening <br />® Quote Award <br />R Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />El Ease/Encroach. <br />0 Traffic Control <br />El Other: <br />Required Information <br />Company or Vendor Name Dynamic Mechanical Services <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />® No ❑ Yes Name of Company <br />Project Name <br />O'Brien Fitness Center HVAC <br />Project Number <br />1088-2019 <br />Funding Source <br />VPA Maintenance <br />Account No. <br />_...............w_.....��.w�.. ............�.�.. <br />201-1101-452.39-89 <br />Amount <br />.$..43,295.0.....................................................................��......��,.,.,.,.,.,.,.,uwuw ,.... <br />0 <br />Terms of Contract <br />Completion in 45 calendar days <br />Purpose/Description <br />Replacing HVAC units at O'Brien Fitness Center <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-V rift', Iran, etc. <br />. ...... <br />Required For ChiemOrders On_... _ w_www w <br />Amount of ❑ Increase $_. _.......................... <br />0 Decrease $ <br />Previous Amount <br />$ <br />CurrentPercent of Change: <br />.�..�.�.�........................................................................................................................._�.�............a............... .�.. <br />.............�A..................................................................................................................�.�.�.�......�............_.._. �_.._.._... ..� <br />New Amount <br />$ <br />Total Percent of Change: <br />__. ......... ..........------_.....� wmw� <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />-.� <br />❑ ❑ <br />................�...,,.�................ .............. �................................................................................�......_............................... �....... ��� <br />