CM-05-03-062REC'D MAP 2 4 200;
Request for City Council/City Manager Action
City Council o 1 City Manager
Submit completed form for all City Manager and City Council approvals.
Department Name: Public Works - Building Construction
Contact Person: Latha Kumar/Laura Flores
Project
Manager/Resource: Larry Madsen
Project Coordinator: Larry Madsen
Assigned Attorney: J. Kay Gayle
Council or I
City Manager 311,25
r 1 �t 5
Agenda Date: ` �J G'
Blue Sheet Wording
Project Name: Senior Activity Center
For Administration Use ONLY
Tag #
Documents .--
Received: '.% » '244 -�
Return to:
Return date:
CC: Lynn Olsen
ContractorNendor: Professional Service Industries, Inc. (PSI)
Funding Source: 2001 Go Bond
Amount: $3,952.00
Consider a-reeeletiew authorizing the City Manager to execute Snpplementel-Agreement, 4•with Professional Services Industries,
Inc. for Construction Materials Testing & Inspection Services for the Senior Activity Center/Parking Garage at 301 West Bagdad for
the amount of $3,952.00.
Finance Information
Is Funding Required? 0 Yes Q No
Finance Approval
Finance
X❑ Finance
iPurchasing
El Budget
Amount
Initial Construction Contract
Construction Contract Amendment #
Change Order #
Change in Quantity
Unforeseen Circumstances
Initial Professional Services Agreement
Supplemental Professional Svcs. A # 1 3,952.00
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased:
/21
ther (Please clleearly.yientify//- action
ron lines below (t',. • -
L. Olsen
N/A E. Wilson
N/A HB
Dale
Date
Date
Date
3/16/2005
3/16/2005
3/16/2005
For Submission to Cit Man a • =-, On
Project Mgr. Signature:
Dept. Director Signature:
City Attorney Signature*:
Date: -1—/6, us
Date: 3-1(6
Date:
City Manager Signature: ,) . Date: 05 05
a� pproval Is required for all items requesting City Manager's approval.
Updated 3-9-05