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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 08/06/16 <br />Name Toy Villa fw�p Department Engineering <br />BPW Date 08/23/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ❑ Controller 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. 2 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />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 <br />Required In <br />Walsh & Kelly, Inc. <br />If Yes <br />❑ No U Yes Name of Company <br />East Bank Sewer Separation — Phase 5 (Division B) Sewer Bond <br />114-062A <br />Sewer Bond <br />1050.460.31.02 <br />Approval of Change Order #2 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment. E-Verifv. Iran. etc. <br />Increase $ 118,071.00 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />❑ <br />® <br />❑ <br />® <br />❑ <br />2.30% <br />$ 5,253,800.66 <br />3.40% <br />Dispersal After Approval <br />Aaron Kobb, Judy Love, Beth Leonard <br />Roger Nawrot <br />Tov Villa <br />