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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/07/17 Department Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />02/14/17 <br />Phone Extension <br />5920 <br />Required Prior to Submittal to Board <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 />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. ® C/O & PCA No. 2 Final ❑ 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 />Amount of <br />Required Intormation <br />HRP Construction <br />❑ Yes ® No ❑ If Yes, Approved by <br />Purchasing <br />❑ MBE ❑ WBE <br />No ❑ Yes Name of Company <br />Chet Waggoner Court <br />116-005 <br />RWDA TIF <br />324.1050.460.31.02 <br />$625,856.95 <br />Project Closeout <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Reauired For Change Orders Only <br />Increase $ <br />Decrease $ 11,579.04 <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Origin <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />-1.82% <br />$ 4343'" 9� WS,`65ko . <br />0.95% <br />