Peralta Community College District
Department of General Services
333 East 8 Street  Oakland, California 94606  (510) 466-7346
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CONSTRUCTION PROJECT REQUEST FORM
This form is to be used to request Measure A, Measure E, and other funding support for
construction and scheduled maintenance projects and related furniture and equipment
expenditures.
INCOMPLETE SUBMITTALS WILL BE RETURNED
INSTRUCTIONS:
1.
2.
3.
Complete SECTIONS I AND II
Obtain required signatures and approvals prior to submittal
Forward the completed Instructional expenditure request form to:
Dr. Sadiq B. Ikharo
Vice Chancellor of General Services
Peralta Community College District Office,
Department of General Services
333 East Eight Street
Oakland, California 94606
Tel: (510) 466-7346
Fax: (510) 466-7315
Form Revised: July 28, 2015
Project No. ______________________
CONSTRUCTION PROJECT REQUEST FORM
SECTION I - PROJECT BACKGROUND
(Check one)
MEASURE A
MEASURE E
OTHER
Date:
Requestor:
Phone No.
Location:
District
Laney
COA
Department :
Requested Funding Amount:
Merritt
Berkeley City
College
Building:
Project Name:
1.
Which best describes this project?
Health and Safety
Emergency Maintenance
Upgrade to an Existing Facility
Classroom
2.
Laboratory
Administrative Space
Student Area
Public Area
Roads and Walkways
Grounds
Create New Facility Space
Other:
Project will require the following:
ARCHITECTURAL
MECHANICAL
Walls/Partitions
Plastering
Masonry/Concrete
Windows
Doors/Hardware
Waterproofing
Insulating
Roofing/Gutters
Woodwork
Other:
Window A/C
Central A/C
Temp/Humid
Controls
Ductwork
Diffusers/Grilles
Exhaust Fan
Fume Hood
Other:
Peralta Community College District
Form Revised: July 28, 2015
ELECTRICAL
PLUMBING
Lighting Fixtures
Receptacles/GFCI
Telecomm Outlets
Power Other than
120V
Dedicated Circuits
Fire Alarm
Emergency Lighting
Other:
Domestic Water
Distilled Water
Air, Gas, Vacuum
Sink / Fixtures
Toilet / Fixtures
Drain Vent
Fire Sprinkler
Other:
Department of General Service
Page 2 of 6
Project No. ______________________
FINISHING
Plastering
Drywall
Wall Coverings
Painting
Vinyl Tile/Base
Carpet/Base
Suspended Ceiling
Other:
3.
FURNISHING
Window Treatments
Fixed/Movable Seating
Modular Office
Furniture
Labor arty Furniture
Display Case
Bookcase Shelving
Custom Woodwork
Other:
Will this be a one-time expenditure?
SPECIALTIES
White/Tack Boards
Chalkboards
Toilet /Shower Partitions
Storage Shelving
Access Flooring
Directories/ Signs
Storage Shelving
Other:
Yes
OTHER SERVICES
Move
Special Event
Landscaping
Fencing
Rekey Door
Hardware
Asbestos Removal
Demolition
Other:
No
If No, how will this project be incorporated as an on-going expenditure into the department,
program, curriculum and budget?
4.
Project description: (You may attach additional information)
5.
Project justification: (Note: Project request must refer to Bond language, if applicable.)
6.
What are the project objectives and benefits to the students, program, and college?
Peralta Community College District
Form Revised: July 28, 2015
Department of General Service
Page 3 of 6
Project No. ______________________
7.
Project estimates: (Please names and list the final cost estimates from three different
vendors, suppliers, or trades. In addition, please attach the original estimates.)
Name
Cost
1.
2.
3.
8.
Appendix Description: (Please list any additional attachments, such as timelines, plans,
sketches etc.)
Peralta Community College District
Form Revised: July 28, 2015
Department of General Service
Page 4 of 6
Project No. ______________________
SECTION II - PROJECT CONTACT INFORMATION
COLLEGE CONTACT INFORMATION
Contact:
Email:
Phone:
COLLEGE APPROVALS
1. OFFICE OF INSTRUCTIONAL SERVICES
Vice President of Instructional Services:
(Print Name)
Signature:
Email:
Date:
Phone:
2. BUSINESS OFFICE
ACCOUNT CODES:
L
FUND
COST
CENTER
OBJECT
PR
ACTIVITY
SPJ
LN
College Business Officer (Required for District Review):
(Print Name)
Signature:
Email:
Date:
Phone:
3. COLLEGE PRESIDENT’S OFFICE
College President (Required for District Review):
(Print Name)
Signature:
Email:
Peralta Community College District
Form Revised: July 28, 2015
Date:
Phone:
Department of General Service
Page 5 of 6
Project No. ______________________
SECTION III –EVALUATION
(DISTRICT USE ONLY)
To be Completed by the Department of General Services
1. Project Name:
2. Budget Expenditure:
3. Facilities Master Plan Scheduled Area Renovation date:
4. The next scheduled maintenance project date for this area:
5. The next scheduled renovation project date for this area:
6. Recommendation:
Approved
Request Incomplete (Please complete highlighted areas) Return by:
Rejected (Review justification below)
APPROVED BY
Dr. Sadiq Ikharo; Vice Chancellor of General Services
Date
Susan Rinne, Interim Vice Chancellor of Finance & Administration
Date
Dr. Jowl C. Laguerre, Chancellor
Date
Peralta Community College District
Form Revised: July 28, 2015
Department of General Service
Page 6 of 6