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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/03/2019 <br />Department VPA: Facilities & <br />Name Patrick Sherman Grounds <br />BPW Date 07/09/2019 Phone Extension 5601 <br />�11 uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuumumminwmwmilu WINS mK <br />Re uired Prior to Submittal to Board <br />Legal Attorney <br />g Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the <br />Ll Agreement <br />Professional Services <br />El Bid Opening <br />Quote Opening <br />Change Order No. <br />❑'Ease/Encroach. <br />6- Other: <br />Michael Schmidt <br />ropriate Item Try <br />E Contract <br />❑ Resolution <br />El Bid Award <br />® Quote Award <br />C/O & PCA No <br />EJ Traffic Control <br />for All Submissions <br />G Proposal <br />[—f Req. to Advertise <br />Retuired Information <br />Company or Vendor Name Dynamic Mechanical Services <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor <br />[:] Yes Z No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE [:] WBE <br />MBE/WBE Contractor Requested ® No n Yes Name of Company <br />Project Name <br />O'Brien Fitness Center HVAC <br />Project Number <br />1088-2019 <br />Funding Source <br />VPA Maintenance <br />Account No. <br />201-1101-452.39-89...................................................�������������������......�n a <br />Amount <br />.mm............ ._..............._�........_�...._�..............................._��wmw �_ � �... <br />$ 43,295.00 <br />Terms of Contract <br />Completion in 45 m calendar days. w..... ..... <br />Purpose/Description <br />Replacing HVAC units at b'Brien Fitness Center <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion Non Discrimination, Non -Debarment, E-Verif „ Iran, etc.) <br />d ..____....�.. ..... <br />Required For Chance Orders Only` <br />Amount of E 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 />E' <br />❑ <br />E <br />