Contract (PO) Number: 5382

Release Number: 104

Specification Number: 17058

Name of Contractor: PACIFIC CONSTRUCTION SERVICES

City Department: DEPT OF GENERAL SERVICES

Title of Contract: JOB ORDER CONTRACT REHABILITATION OF CITY FACILITIES -TARGET MARKEY

Dollar Amount of Release: $2,881.90

GENERAL CONSTRUCnON - PUBLIC WORKS RELATEDRelease Description:

Procurement Services Contact Person: BYRON WHIlT AKER

Vendor Number: 1042543

Submission Date:

CITY OF CHICAGOBLANKET RELEASE Original (Department)

Furnish the supplies and/or services described below in confot'mance with conditions set forth herein and In your offer

SITENAME

A

DELIVERYDATE

PAGENUMBER

RELEASENUMBER

SPECIFICATIONNUMBER---

PURCHASEORDER

1104 17058

VENDORNUMBER

1042543

RELEASEDATE

0710712005 5382

ORDERED FROM:DELIVER TO: 38-038

~

DELNERY CHARGES to be PREPAIDTITLE TO PASS ON DELNERY

CONTACT: Staci Rae Bixler 744-1636PO DESCRIPTION: JOB ORDER CONTRACT REHABILITATION OF CITY FACILITIES - TARGET MARKEY

BLANKET RELEASE

THIS SIGNED RELEASE IS YOUR AUTHORITY TO FURNISH THE SPECIFIED SUPPLIES AND lOR SERVICES IN ACCORDANCEWITH THE TERMS AND CONDITIONS OF THE BLANKET AGREEMENT NUMBER: 5382

THIS PURCHASE IS FOR DEPARTMENT: 38 - DEPT OF GENERAL SERVICES

SUBMIT THE ORIGINAL INVOICE TO:

UNITCOST

1.00

PO ShipLine Line

1 1

TOTAL COST

2,881.90

COMMODITY INFORMATION QUANTITY

96842 2,881.90GENERAL CONSTRUCTION - PUBLIC WORKS RELATED

UOMUSD

RELEASE TOTAL: 2,881.90

x~

,.

Payment on this order will be made upon receipt of an original vendor Invoice form referencing this order.Submit the original invoice to the department referenced above.

Mark all packages and papers with the purchase number.Any deliveries containing overshipments will be reflected unless otherwise authorized in this purchase.

This purchase is subject to the City of Chicago General Conditions for Supplies. Work, or Professional Consulting Services; Special Conditions, DisclosureOwnership, Acceptance Page, as applicable, which are attached hereto or incorporated herein by reference.

City of ChicagoDepartment of General Services30 North LaSalle StreetChicago, IL 60602

To: Department of General Services

Sub-Order Total: 2,881.90

Disclosure of Retained Parties

A. Definitions and Disclosure Reauirements1.As used herein, lI1e Iem1 "Contractor- means a PefSOn or entity who has any contracllease with the City of Chicago.2. Pursant to Executive Order 97-1, every dIy contract and lease must be accompanied by a di~ure statement

Providing cer1ain information and attorneys, ~sts, accoun1a{11s, consultants, sub<xm1radors ,and other personsWOOm the cartIacIor has retained or expects to retain with respect to lI1e contract or lease. In particular, the contactormust(fis(:k)Se the name of each such person, lis or her business address, the nature of lI1e reIationship,and the

~ of fees paid or estimalBd. to be paki.3. The ContIactor is not ~uir8d to disck)Se emp~ who are paid solely II1rough the Contractor's regular payroll.4."Lobbyist" means any person (a) who for compensatk>n or on behalf of any person other than himself undertakes to

Influence any legislative «admmistratDI action, or (b) any part or whose dutias as an employee of another

Includes undertaking to influence any IegisIaIive « administrative action.

B. Certification

:ontratMJr her8DI ~r1IfIeS as follow!

TM Disclosure relates to the follCPNing ~:

PrqecI name: JTP586.A EC 88 RcxJf Repel

5382/17058Specilicalion,k)an or other identifying number:

2. Name of Contractor: padfic Constndlon Services, Inc.

3. EACH AND EVERY at1omey, ~ 8CQ)Untant,COI1sultant, sutx:ontractor, or other persoo retained or anticipatedto be retained by the Contrador with r88ped to or In connection with the contrad or lease is listed belON

(8ttadI additkmaI pages If neC28S8ry):

CI Knlckerbod<er Roofing

RelationShip(attorney, lobbyist,subcontractor ,etc.)

FEE(indicatewhether paidor estimated)

BUSINESSADDRESS $

c c

~ISubcontractol16328 S Lathrop Ave

Harvey, IL, 60426$2,000.00 Est.

Subcontractor $881.90 EstI Pacific Construction Services

Date

.j&C- ~ rOo)!,"",-\- "Id"XCLlA4.:.\/.:R.-~~TItle

~C>.f\

Disclosure Statemer

~

~- -CHECK HERE IF NO SUCH PERSONS HAVE BEEN RETAINED OR ARE ANTICIPATED TO BE ~ETAINED

4. The Conb"adtX Undsstands and agrees that the city may rely on the infonnatlon provided herein and 1hat providingany false i~pIete or inaccurarx:e information shall IXXIstitute default under 1he contract and may result In

termllation of 1M contract or lease5.The ContradtX understands and agress that in any case in which the Conb"adtX is uncertain whether a dlsdOlUfe Is required under the Executive order, the Contractor must eith.

ask the city whether discbsure is required or make the disclosul8.

Under the ~ of ~ulY . I..~ that I am auth~ 10 execute this Disclosul8 Dr! behalf of the Contractor that the information disclosed hel8in is true and (X)Inplete, and that nc

...

November092004

City of ChicagoRichard M. Daley, Mayor

Mr. Eric J. GriggsChief ProQJrement OfficerDepartment of ProaJm1ent ServicesCity HaJl, Room 403121 North laSalle StreetChicago, II 60602Department of General Senicel

Michi E. PeliaCommiuiooer Attn: Catherine Mellon

JOC ManagerSuite 370030 NCX1h LaSalle StmtOticsgo, Olinois 60602-2586(312) 742-3124(312) 744-9883 (FAX)

bttp://www.cityofchicaao.orl

Re: JOC Project Number:

Project Title:

Add,...:

JTP586.A K4097

Engine Company 88 - Emergency Roof Repairs

3500 W. 60th Sl

6.000.00

17058

04-492-38-2005-4057-0540-50031-15-1

Estimated Cost:

Specification Number:

Funding Source:

Dear Mr Griggs:

We request that the above referenced project be contrad8d under the Job OrderContracting (JOC) Method. Attachment A describes the scope of wor1< and theappropriateness for using JOC for this prqect.

Please dired all ted1nicallnquiries to Projed Manager 744-6268 and all other inquiries to Staci-Rae Bixler at 744-1636.

If you concur with our recommendation, please sign beiaN and return a copy for our

files.

Sincerely,

~~~~.;(- _/~~~~~~ --Michl E. PensCommissioner

04=--APPROVED:

AppoV8d:

Eric J. Griggs -~

Chief Procurement Officer

Jo/VI PIezbert 1fN~ ~~~?2~

M8y ~L/L-

J81ryMcG-.nmBUILDING CHICAGO TOGETHEB

-.

The Department of General Services

JOC Approval LetterUtilizinG JOC For CItY Construction Proiects

Engine Company 0883500 W. 60th St

Project No: JTP588.A--~~--- -~---~

For aA Proposed JOC Projects. Please complete Items 1 and 2 below. As appropriate, Complete items 3,4 and 5. Attachto MOA (JOC Approval ~)

Plea.. describe the major features of thia project.

Emergency repairs to existing firehouse roof.

Please explain why this project could not be bid using the city's traditional bid process and the need to useJOC Procurement system.

No Roofing Term Agreement in pla~.

3. If the project is . one trade project, please provide additional explanation of why it would not be in the city'sbeat interest to do the project under JOC.

No

4 If it is anticipated that over 25% of the project will consist of Non-prepriced items, please provide anexplanation on why JOC should be used.

No

5. If some elements of the proposed JOC Project scope of work are covered by city term agreements, these

elements should be removed from the JOC Project.

No

1

"'" .

DEPARTMENT OF GENERAL SERVICESBureau of Architecture, Engineering & Construction Management

JOB ORDER CONTRACT (JOC)REOUEST FORM

Client Department: Date: 11/Q/M -

~11~~n ~rAAn PhOI)A ~ 1 ?- 7 U-R?RROriginator:

Project Number KdnQ7 1.ITP5RGA

FN(;'INF ~n RR - FMFR(;'FN~V Rnn~ RFP4.IR~Project Name:

Location/Address: ~-"nn WA~t "nth ~trAAt

Project Scope: T em~ora~ re~airs to existing roof to crevent leaks & further waterdamage. until firehouse moves to new location.

Justification: ThA ~ii¥WirtA Rnnfing TArin AgrAAmAnt AYpirArl~

A new term agreement is under develo~ment & ~endingfinalization with Procurement.-

Est. Project Budget: $ R.nOO nn

Funding Strip(s): )40-50031-151 ~ S6.000.00= ~ fqlD'/~ 00 . r I ~

~ Date: -r 0 .

Can this request be completed by anyone of the following1. In-House Trades Yes 02. Term Contract Yes 03. Competitive Bid Yes 0

NOLNOLNoL

If not for arrJ'of the above, please explain:Construction s~ecialty to be subcontracted thru the current JOC contractwith Pacific Construction Services.

-APPROVED:

/~-J~ ~~

.,/.. DepU~miSSiOnerNicholas J. Date

/I""_f~DateJohn .l Plezbert. 2: Deputy Commissioner