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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />01/06/2017 <br />Richard Estes <br />Department <br />Division/Bureau <br />Public Works <br />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 ❑ 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 Appropriate Item Type — Required forAll 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. 2 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <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 />Holladay Construction Grou <br />n Yes N No n If Yes. An <br />MBE <br />U No Lj Yes Name of Company <br />Century Center — Service Court Improvements <br />116-006 <br />Hotel -Motel Tax <br />7304-42010-0000-0099 <br />Change order to reflect deduct from unused utility allowance <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Orders On <br />Amount of <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />$ 147,513.00 <br />13.46% <br />py <br />Herczeg, Leanna Belew <br />Joe Nucciarone (AI <br />(Holladay Constructioi <br />Original <br />® <br />❑ Scott <br />® <br />❑ Bill Lamie, <br />® <br />❑ Al Lusk <br />