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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/06/2017 Department Public Works <br />Name Richard Estes Division/Bureau Engineering <br />BPW Date 01/24/2017 Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <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 ® George King <br />r 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. 1 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />I-1 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 L I Increase <br />® Decrease <br />116-010 <br />Hotel -Motel Tax <br />7304-42010-0000-0099 <br />Change order to reflect changes to scope of work due to <br />unforeseen conditions involving both General Construction and <br />Electrical, as directed by the Owner. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Previous Amount $ 218 <br />Current Percent of Change: (5.K <br />New Amount $ 205 <br />Total Percent of Change: (5.86) <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />and add 28 calendar <br />s:- <br />Leanna Belew, Scott Herczeg (Century Center) <br />Bill Lamie. Joe Nucciarone (Alliance) <br />AI Lusk, Holladay Construction Group <br />