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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/21/2023 <br />Name Patrick Sherman Department Public Works <br />BPW Date 11 /26/2023 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 />Check the Appropriate Item I <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Bid Opening <br />® Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />I-1 Other: <br />Michael Schmidt <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />Company or Vendor Name <br />TBD <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑❑ MBYes <br />MBE/WBE Contractor <br />E Completed E-Verify Form Attached ❑ <br />No <br />Project Name <br />Studebaker Museum HVAC Replacement <br />Project Number <br />124-020 <br />Funding Source <br />PR-00036580 <br />Account No. <br />324-10-102-121-443001--PROJ00000524 <br />Amount <br />$TBD <br />Terms of Contract <br />Lump Sum Quote <br />Purpose/Description <br />Replacement of two end of life and failing condensing units at the Studebaker <br />Museum. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: <br />