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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />01/17/2017 <br />Department <br />Public Works <br />Name <br />Toy Villa �� <br />Division/Bureau <br />Engineering <br />BPW Date <br />01/24/2017 <br />Phone Extension <br />5920 <br />l <br />Required Prior to Submittal to Board <br />Legal ❑ <br />Attorney Name: Michael Schmidt <br />Controller ❑ <br />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 />George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />® <br />Change Order No. 1 <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control: <br />n <br />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 <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanoe: <br />py <br />Original <br />® <br />❑ <br />® <br />❑ <br />uired Information <br />HRP Construction Inc. <br />LJ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Berlin Place Site Development <br />116-089 <br />RWDA TIF <br />324-1050-460.31-02 <br />$490,500.00 <br />Utility relocation work at Berlin Place <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />equired For Change Orders Only <br />$ 2,352.00 <br />490, 500.00 <br />0.48% <br />$ 492,852.00 <br />0.48% <br />Dispersal After <br />Nawrot <br />Chris uhockley, Brett Konarski (JPR) <br />Patrick Kerr <br />