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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/29/2017 Department <br />Name Toy Villa Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 12/12/2017 Phone Extension 5920 <br />Legal F-1 Attorney Name-, <br />Controller El 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 n <br />F] Agreement Amendment LI Contract L] Proposal H Addendum <br />El Professional Services r! Resolution <br />E] Bid Opening ❑ Bid Award E] Req. to Advertise ❑ Title Sheet <br />El Quote Opening ❑ Quote Award <br />F-1 Change Order No. C/O & PCA No. 1 (final) R PCA <br />El Ease/Encroach, Traffic Control. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />C & E Excavating, Inc <br />El Yes ZI No E] If Yes, Approved by <br />Purchasing <br />❑I MBE [:] WBE <br />El No El Yes Name of Company <br />Olive Street Metronet Conduit <br />117-021 <br />River West TIF <br />324.1050.460.42.03 <br />Pr 'ect Closeout <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non-Discriminabon, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $1,255-50 <br />Decrease $ <br />Previous Amount _$ 127,395,.00 <br />Current Percent of Change: 0.99% <br />New Amount $ 128,650.50 <br />Total Percent of Change: 0,99% <br />Copy <br />Original <br />F-1 <br />El <br />11 <br />n <br />El <br />n <br />