Contract (PO) Number: 7119

Release Number: 3

Specification Number: 23505

Name of Contractor: MECCORINDUSTRIES Lm.

City Department: DEPT OF A VIA nON

Title of Contract: JOB ORDER CONTRACT FOR RENOV A nON OF AIRPORTFACILmES

Dollar Amount of Release: $9,009.00

Release Description: GENERAL CONSTRUCTION

Procurement Services Contact Person: BYRON WHITTAKER

Vendor Number: 1004648Submission Date:

CITY OF CHICAGOBLANKET RELEASE Original (Department)

Fumiah ItI8 ~ ...~ ~ aec;.-a.r= below kI confom..- will condIIIofI8 8et fOIttI herein .1Id In your offer

PURCHASEORDER

RELEASENUMBER

SPECIFICATIONNUMBER

SITENAME

A

DEUVERYDATE

PAGENUMBER

---RELEASE

DATE

07/12/2005 7119 3 23505

VENDORNUMBER1004648 1

DEUVER TO: 85-085 ORDERED FROM:--085- O'HARE

I O'HARE AIRPORT

Chicago, IL 60666

DELIVERY CHARGES to be PREPAIDTITlE TO PASS ON DELIVERY

I :"'~PTION: ~E:~~:~~~~~;~~:~ CONTACT: VALERIE WALKER 77MM-3584

PO DESCRIPTION: JOB ORDER CONTRACT FOR RENOVATION OF AIRPORT FACILITIES

~BlANKET RELEASE

THIS SIGNED RELEASE IS YOUR AUTHORITY TO FURNISH THE SPECIFIED SUPPUES AND lOR SERVICES IN ACCORDANCEWITH THE TERMS AND CONDITIONS OF THE BLANKET AGREEMENT NUMBER: 7119

THIS PURCHASE IS FOR DEPARTMENT: 85 - DEPT OF AVIATION

SUBMIT THE ORIGINAlINVOtCE TO:

PO ShipLI,. LIne

1 1

UNITCOST

1.00

QUANTITY

9.009.00

COMMODfTY INFORMATION

96842

GENERAL CONSTRUCTION

UOM

USD

TOTAL COST

9,009.00

JM-5030; MIDWAY LIGHT POLE BASE RESTORATION

Dlst BFY FUND COST CTR APPR ACCNT ACTV1 00 1 0603 0854350 5027 ~ (XXX)

PROJECT APT CAT GENAL FUTA

M5O275OE (XXX)()() ()()()()() (XX)()

SHIPMENT TOTAL:

9,009.00

1,0(».001

RELEASE TOTAL: 9,009.00

SIG~~ d- 8:!.v~DATE

P8yment on this Ofdef will be mede ~ receipt of an Oflglnal vendor klvoIce fonn referencing this Of".Submit the Ofiglnll kwoice to the depertment referenced e-.

M8rfI .11 pecka9H end p8p8r8 with the ~ nI8nber.Any deliveries conl8k1ing overMipmerd8 will be reflected 1m"" otherwi.. euthorlz8d In thle purchaM.

Thle purche.. Ie eubject to the City of Chicego Gener.1 Conditions fOf Supplies. WOfk, Of Profe..i0n81 Consulting Services; Speclel Conditions, Di8c1osureOWnerShip, Accepence Page,.. appliceble, which.re att8dMd hereto Of incOlporeted herein by r"'«..~..;6.

Date: May 03, 2005

,~.c c---

A. Definitions and Disdosure ReQuirements.1.As ~ herei1, the term "ConUaclor" means a person or entity ~ has any contract lease wtth the City of Chicago.2.Pursant to ExeaItiYe Order 97-1 ,every city contract and lee.. must be ~penied by . disclosure statement

Providing cer1ain infoonatIon and attorneys, 1obbyiS1S, ~nlanta, conaultanla, subcontr8clora ,and other personsWhom the contractor has retained or expects to reI8in wtth rupect to the contract or I_. In pertialiar, the contactolmust diIcIose the name of each such peI'IorI, his or her bus/Ilea address, the nature of the reIationShip,and theamount of fees paid or estimated to be peld.

3. The ContradOr is not required to disdoae employees who are paid solely through the C~r's regular payroll.4."Lobbyilr meens any person (a) who for compensation or on behalf of any person other than himself und8l1akes to

inftuence any IeglsJaliYe or administration action, or (b) any pelt or whose duties as an employee of anotherincludes undertaking to inftuence any legislative or adminiStrative action.

B. CertifICation

Contractor hereby certifies 8S

Thi8 DIsdOIurw relates to the following transaction:

project name: JM 5030 Light Pole Base Rei

ipecificatior Ian or other identifying number: !35G

Name of Contractor: :ity of Chicago - DOA ' M8CQ)r Industries,

EACH AND EVERY attorney, IOObyist, ~~~1tInt, subcx.lu.aor. or other perIon re1a/ned or anticipatedto be retained by the Cootractor with respect to or in (X)IInedIon with lie ~ or lease is listed below(attach ad~ooal pages if necessary):

MBEWBE

or Non

FEE(irwhethor estl

BUSINESSADDRESSName $

Meccor Industries MBE

RelationShip(attomey,lobbylst,subcontractor ,etc.

Subcontractor $819.00 Est

C)'Brien & Associates,lnc. Subcontrador $8,190.00 .3933 Oakton StreetSkokie, II, 60076 -

1235 E. Davis Street WBEArlin ton H' hts, IL, 6000

---

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

~. The Contractor Understands and agrees that the city may rely on the information provided herein and that provid~ )any faIte InCXImpIete or In~rance information shall consUtute default under the ~trad end may result intermination of the oontrad or lease5. The Contractor understands and egress that in any case in which the Conttactor is uncertain whether a diadosure II required under

ask the city whether disclceure Is requited or make the diadosure.Ie ContradDr must ei:xecu1ive orne.

Under the PenaIII8I of perju!y . I certify that I am 8JthorIZ8d to ~thi8 DIllI8ievant J~~rs been withheld.

)Sure on behalf of COntra4 118t... s InI8 and complete, and th8tI8tion disclosed ,..

MAY 03,2005

s'f!:JIure Date

PROJECT KABAGER

Title

J AHE S P. HARRER

Disclosure Statement

tdlcateler paidmated)

May 11 2005

City of ChicagoRichard M. Daley, Mayor

Ms. Mary A DempseyInterim Chief Procurement OfficerDepartment of Procurment ServicesCity Hall, Room 403121 North LaSalle StreetChicago, 1160602

Attn: Catherine MellonJOC Manager

Department of Aviation

John A. RobersonCommissioner

Chicago O'HareInternational AirportP.O. Box 66142Chicago,lllinois 60666(773) 686-2200(773) 601-8333 (rrY)

Re: JM5030

Light Pole Base Restoration- Design

10,000.00

23505M5027

JOC Project Number:

Project Title:

Estimated Cost:

Specification Number:

Funding Source:

Chicago MidwayInternational Airport5700 South Cicero AvenueChicago, Illinois 60638(773) 838-0600(773) 838-0795 (ITY)

www.f1ychicago.com

Dear Ms. Dempsey:

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

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

files.

s~ ..

~berson

~r

APPROVED By:

APPROVED:

Patrick J. IFirst Deputy Commissioner

Mary A. DempseyInterim Chief Procurement Officer

.,\,-\C4

.c.:.~ QO

...i~~~§j, ~ ~~ ..

.~rt5i"'."".;.;...

CH~ O'HARe-.- ~ If ~ AIEIw;A,-,-_ZIIt 3maXD

Attachment II A II

Project Number: JM5030 Department: Midway

Project Manager Keisha Johnson Telephone Number: (773) 838-0196

1.) Description of Project

2

The project consists of the completion of all architecturaVengineering documents required for the repairof the light pole bases on the 6th level of the parking garage.

Suitability for JOC Procurement System

This project is appropriate for the JOG Program because the scope of work falls directly under therequirements set forth in the JOC Contract and all items in the cost proposal will conform to the JOC UnitPrice Book.

3 Construction Trades

The scope of work will be in accordance with the detailed specifications of the JOC ContractDocuments.

4 Non Pre-Priced Proposals

Non-applicable

5 City of Chicago Term Contract Scope of Work

The City of Chicago does not hold a term contract for this scope of work