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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 4, 2017 <br />Name Roger Nawrot <br />Department <br />Division/Bureau <br />Engineering <br />DPW <br />BPW Date 12/12/17 Phone Extension 5933 <br />U Agreement <br />U Contract U Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />® Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />I —I Other: <br />Company or Vendor Name <br />Pemberton Davis Electric <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved b <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />College Avenue & Sunnymede Avenue Traffic Calming - Solar <br />Project Name <br />Radar Speed Display Signs <br />Project Number <br />117-113A <br />Funding Source <br />LRSA <br />Account No. <br />251-0608-431.42-96 <br />Amount <br />$25,420M <br />Terms of Contract <br />Completion date of <br />Purpose/Description <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E -Verify, Iran, etc.) <br />Required ForChange Orders Only , <br />Amount of ❑ Increase <br />$ <br />❑ Decrease <br />$ <br />Previous Amount $ <br />Current Percent of Change: <br />% <br />New Amount $ <br />Total Percent of Change: <br />% <br />Dis ersal After Approval <br />Copy Original <br />Y1 ❑ <br />❑ ❑ <br />❑ ❑ <br />