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BOARD OF PUBLIC WORI(S, <br />AGEND�A ITEM REVIEW REQUEST FORM <br />Date 11/30/2017 Department Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />12/12/20117 <br />Phone Extension <br />. .. ....... <br />5920 <br />Legal M <br />Attorney Name: Michael Schmidt <br />Controller 0 <br />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 Z <br />George King <br />Check the Appropriate <br />item Type — Required for All Submissions <br />Q Agreement <br />F Contract F-1 Proposal E] Addendum <br />F Professional Services <br />F Resolution <br />F-1 Bid Opening <br />F-1 Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />[:] Quote Opening <br />[:] Quote Award <br />Z Change Order No. 1 <br />F-1 C/O & PCA No. E] PCA <br />F-1 Ease/Encroach. <br />F-1 Traffic Control: <br />F-1 Other: <br />Company or Vendor Name, <br />New Vendor <br />MBEIWBE Contractor <br />MBEANBE 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 0 <br />El <br />HRP Construction Inc. (Divisions B & C) <br />El Yes Z No [J If Yes, Approved by Purchasing <br />❑ MBE [:1 WBE <br />❑ No 0 Yes Name of Company <br />Newman Center Site Development <br />117-06OR <br />REDA TIF <br />429,.1050.460.42.03 (Division B & C) <br />Approval of C.O. #1 <br />n Required Contractor's Certification Forms Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc, <br />Increase $22,403.42 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />$ 184,353.12 <br />12.15% <br />$ 206,756.54 <br />12.15% <br />Copy <br />Original <br />0 <br />F] Brad Embe,rton - Developer <br />❑ <br />F] <br />❑ <br />El <br />