PSA - Investigation and Repair of Damaged Vault Ceiling at 1201 Western Ave. - American Structurepoint, Inc.

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 2/3/20 Department Name Kyle Silveus En ineerin BPW Date 2/11/20 Phone Extension 9083 _. _p._._.. _ _ ..... .. ............. ....... __............ .....�. Review and Approval lie wire' Prior to Submittal to Board Diversity Compliance El and Inclusion Officer Officer Name BPW Attorney... .... ......... ... ��..._........� ® Attorney Name Clara McDaniels Dept. Attorney F-] Attorney Name Purchasing ❑ Check the Appropriate Item Type Professional Services Agreement Contract Open Market Contract n Amendment/Addendum Bid Opening E] Bid Award Quote Opening Quote Award E] Proposal Opening ❑ C/O & PCA No. ❑ Chg. Order, No. ❑! Traffic Control Other: Company or Vendor Name American New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information Inc. All Submissions Proposal LJ Special Purchase, QPA F-I Req. to Advertise ❑ Reject Bids/Quotes PCA Resolution Ease./Encroach LJ Yes H If Yes, Approved by Purchasing F-1 No ❑ Title Shee ❑ MBE Completed E-Verify Form Attached Yes ❑ WBE No _ Structural Inspection and Repairmen. Western Ave. Stru n ...._ .... ....... 120-019 Engineerin..Professional Services mm.--.......m.........................................www m..... .... 101-0602-431-3106 $6,180 HNTE Investigation and repair design for damaged vault ceiling under sidewalk at 1201 Western Ave. For Ch n Orders Only, Increase . $ ........_..mw.... Amount of _� _......mm..mm _ . ....__. Decrease ($ Previous Amount $ Increase %�.�. �...............ww Current Percent of Change: Decrease ( % New Amount $ _ Increase........................................................._..... o �o Total Percent of Change: Decrease „% Time Extension Amount: New Completion Date: