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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/20/2016 Department <br />Name Richard Estes Division/Bureau Engineering <br />BPW Date 9/27/2016 Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <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 ® George King <br />Check the <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />® Change Order No. 1 <br />❑ Ease/Encroach. <br />F1 Other: <br />Company or Vendor Name <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control: <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 <br />Majority Builders <br />❑ Yes ® No <br />Purchasing <br />❑ MBE ❑ WBE <br />No Yes Name of <br />Marriott Hotel Site Devel <br />116-021 <br />RWDA TIF <br />324-1050-460-3102 <br />Public Works <br />❑ Req. to Advertise <br />❑ PCA <br />It Yes, App <br />Eii <br />Addendum <br />❑ Title Sheet <br />Phase I <br />Change order to reflect delay claims of added cost and 13 <br />calendar days (9 working days) due to the unforeseen <br />encountered rubble during excavations for the foundations. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Increase $ 87,580.45 and add 13 calendar <br />Decrease $ <br />Previous Amount $ 731,348.93 <br />Current Percent of Change: 11.98% <br />New Amount $ 818,929.38 <br />Total Percent of Change: 11.98% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Patrick C. Kerr, Jitin Kain <br />® ❑ Christopher Chockley (JPR) <br />® ❑ Matt Flick, Majority Builders <br />