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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/13/16 <br />Name Toy Villa Department Engineering <br />BPW Date 12/27/16 Phone Extension 5920 <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 />"Agreement L] Contract L-J Proposal U 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 />I -I 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 />❑ No ❑ Yes Name of Company <br />Fellows Street and Dubai[ Street Neighborhood Improvements <br />116-041A— Division B <br />RWDA TIF <br />324.1050.460.31,02 <br />Project Closeout <br />❑ Required Contractor's Certification Form Attached (Non - <br />Amount of H Increase $ <br />® Decrease $ 1,380 <br />Previous Amount $ 47,590.00 <br />Current Percent of Change: 2.90% <br />New Amount $ 46,210.00 <br />Total Percent of Chanae: 2.90% <br />Copy <br />Original <br />® <br />❑ <br />Elizabeth Maradik <br />Villa <br />sr Nawrot <br />