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Date <br />Name <br />BOARI) OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />December 19, 2017 <br />Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 21, 2017 Phone Extension 5932 <br />PriorRqulred to S u brn itta I to Board <br />Legal Attorney Name: Michael Schmidt <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing E <br />LJ Agreement <br />[:] Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />F-1 Change Order No. <br />F-1 Ease/Encroach. <br />L_J Contract <br />❑ Resolution <br />H Bid Award <br />F1 Quote Award <br />E] C/O & PCA No <br />El Traffic Control: <br />N I <br />MEMM <br />0 Req. to Advertise El Title Sheet <br />Company or Vendor Name Walsh & Kelly, Inc. <br />New Vendor F-11 Yes MI No ❑ If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />IJ MBE " WBE <br />MBE/WBE Contractor Requested <br />EJ No E] Yes Name of Company <br />Project Name <br />Ironwood Sidewalks <br />Project Number <br />117-033A <br />Funding Source <br />LRSA-Major <br />Account No. <br />251-0608-431.42-96 <br />Amount <br />$ 182,984.50 <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />[:1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F] increase $ <br />F] Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chancie: <br />Copy <br />Original <br />0 <br />0 <br />F] <br />❑ <br />es <br />