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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />11/2717 <br />Department <br />Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />12/12/17 <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 $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing F-1 <br />Ll Agreement <br />H Contract n Proposal El Addendum <br />El Professional Services <br />n Resolution <br />n Bid Opening <br />F] Bid Award E] Req. to Advertise E] Title Sheet <br />F-1 Quote Opening <br />0 Quote Award <br />Z Change Order No. 3 <br />El C/O & PCA No. ❑ PCA <br />F-1 Ease/Encroach. <br />❑ Traffic Control: <br />❑I Other: <br />Company or Vendor Name Insituform Technologies <br />El Yes Z No ❑ If Yes, Approved by <br />New Vendor Purchasing <br />MBEANBE Contractor H MBE U WBE <br />MBEANBE Contractor Requested ❑ No L] Yes Name of Compan <br />Project Name 2016 Manhole and Sewer Lining <br />Project Number 116-026 <br />Funding Source Sewer Contractual Service <br />Account No. 641.0621.792.63.35 <br />Amount <br />Terms of Contract <br />Purpose/Description Approval of Change Order #3 <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Ye�rl_ra etc.� <br />R I quired.ro(C�h"pqge L�roe'$" , y <br />Increase $2,698.50 <br />Amount of F-1 Decrease $ <br />Previous Amount $ 2,993,637.5,5 <br />Current Percent of Change: 0.09% <br />New Amount $ 2,996,336.05 <br />Total Percent of Change: 1.30% <br />Copy Original <br />M F1 Toy Villa <br />F1 R <br />El El <br />