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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW REQUEST FORM <br />Date December 5, 2017 <br />Name Tara Weigand <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 12, 2017 Phone Extension 5998 <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 />F] Agreement Amendment <br />L-1 Contract ❑I Proposal LJ Addendum <br />❑ Professional Services <br />F-1 Resolution <br />Bid Opening <br />n Bid Award El Req,. to Advertise E:1 Title Sheet <br />❑ Quote Opening <br />Z Quote Award <br />❑ Change Order No. <br />0 C/O & PCA No. El PCA <br />❑ Ease/Encroach. <br />F-1 Traffic Control: <br />El Other: <br />Required Information <br />Company or Vendor Name <br />Edward J. White, Inc. <br />El Yes Z No E] If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEANBE Contractor <br />[J MBE F-1 WBE <br />MBE/WBE Contractor Requested F1 No E] Yes Name of Company <br />Project Name <br />Centur Center Vestibule Heater <br />Project Number <br />117-044 <br />Funding Source <br />Hotel -(Motel Tax <br />Account No. <br />7304.42010.000.0099 <br />Amount <br />$32,205.00 <br />Terms of Contract <br />Purpose/Description <br />Replace the vestibule heater at the west entrance to the Century <br />Center <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, No n-Discrim !nation,, Non -Debarment, E-Verify, Iran, etc.) <br />Rid q,uired For Change Orders Only <br />Amount of El increase $ <br />FI Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />n Tom Cook, WE Designs <br />E] Scott Herczeg, Century Center <br />❑ 0 Le,anna Belew, Century Center <br />