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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 2, 2016 <br />Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />BPW Date August 9, 2016 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name: <br />Controller El greater <br />review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 3 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of H Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Chanqe: <br />py <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />)artment of Transpi <br />It Yes, Approved by <br />U MBE LJ WBE <br />❑ No Yes Name of Company <br />Olive Street and Sample Street Reconstruction <br />113-002 <br />Major Moves <br />412-0414-1542.03 <br />$0.00 <br />Federal 80%, City 10% & County 10% <br />This change order is for changing the replacement of the traffic <br />signal fiber conduit from non -participating to FHWA participating <br />contract items. This represents a savings of $36,716 on what <br />the City's final cost will be for the overall project. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Nawrot <br />uired For Chanqe Orders <br />