Welcome to www.houstonmunicipalart.org

This form is to be completed as part of the Artist deliverables for their Project. The information provided by the artist/fabricator will be used as a record as well as to provide maintenance directives.

Form Completed By ...
E-Mail ...
Phone ...

ARTIST / DESIGN TEAM
ARTIST 1
Artist 1 Name:
Artist 1 Address:
Artist 1 City:
Artist 1 State:
Artist 1 ZIP:
Artist 1 Phone 1:
Artist 1 Phone 2:
ARTIST 2
Artist 2 Name:
Artist 2 Address:
Artist 2 City:
Artist 2 State:
Artist 2 ZIP:
Artist 2 Phone 1:
Artist 2 Phone 2:
ARTIST 3
Artist 3 Name:
Artist 3 Address:
Artist 3 City:
Artist 3 State:
Artist 3 ZIP:
Artist 3 Phone 1:
Artist 3 Phone 2:

Project:
Element:
Specific Location:

Commissioning Body
Body Name:
Body Address:
Body City:
Body State:
Body ZIP:
Body Contact:
Body Phone:
Body E-Mail:

Principal Design / Engineering Firm
Firm Name:
Firm Address:
Firm City:
Firm State:
Firm ZIP:
Firm Contact:
Firm Phone:
Firm E-Mail:

Statement of Artistic Intent:


DIMENSIONS:
Height:
Width:
Depth:
Approximate Weight:

Fabricator
Fabricator Name:
Fabricator Address:
Fabricator City:
Fabricator State:
Fabricator ZIP:
Fabricator Contact:
Fabricator Phone:
Fabricator E-Mail:
Date Fabricated:

Medium / Materials
Manufacturers' brand name(s):

Material Finish
Fixatives, retardants, glazes, tool patterns, patina, surface sealers (include brand names)

Construction Technique
Include welding method, rod alloy, joint material, and/or joining method

Foundation Structure
Bolt/pin size; grout; anchor system

Location of Signature / Copyright and/or Identifying Plaque:


Was a conservator consulted for recommendations?
YES	NO
If YES ...
Conservator Name:
Conservator Address:
Conservator City:
Conservator State:
Conservator ZIP:
Conservator Contact:
Conservator Phone:
Conservator E-Mail:

Do you intend for the work to reflect environmental impact / weathering?
YES	NO

Describe in detail the routine maintenance required, procedures and agents to be used.


Frequency of maintenance?

Special skills or training, if any, needed to perform maintenance:


Do you wish to participate in routine and / or annual maintenance?
YES	NO

Names of acceptable maintenance contractors:


Additional maintenance comments: