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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/15/16 <br />Name <br />Toy Villa <br />Department <br />Engineering <br />BPW Date <br />12/22/16 <br />Phone Extension <br />5920 <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 />❑ 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. ® C/O & PCA No. 1 Final ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F1Other: <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 />TX Concrete LLC <br />Pu <br />❑ No ❑ Yes Name of Company <br />2016 Curb and Sidewalk Construction Phase III <br />116-029B <br />MVH <br />202.0619.431.31.06 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Previous Amount $ 13,930.00 <br />Current Percent of Change: 0.55% <br />New Amount $ 14,007.21 <br />Total Percent of Change: 0.55% <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />0 <br />Terri Swift <br />Villa <br />