Change Order No 2 & PCA - Main St at Washington St Roadside Improvements Proj No 116-001A - Premium Concrete Services Inc

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/12/17 Department Name Toy Vi11W Division/Bureau Public Works Engineering BPW Date 12/21/17 Phone Extension 5920 Legal ❑ Attorney Name: Controller Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing El ❑ Agreement Amendment H Contract H Proposal Addendum Professional Services El Resolution ❑ Bid Opening F-1 Bid Award ❑ Req. to Advertise El Title Sheet ❑ Quote Opening F-1 Quote Award El Change Order No. Z C/O & PCA No.2 ffinal) F-1 PCA F] Ease/Encroach. F-1 Traffic Control: F-1 Other: Company or Vendor Name Premium Concrete Services, Inc. D Yes F1 No Ll If Yes, Approved by New Vendor Purchasing MBEANBE Contractor 0I MBE F] WBE MBE/WBE Contractor Requested F-11 No 0 Yes Name of Company Project Name Main Street at Washington Street Roadside Improvements Project Number 116-001 A Funding Source TIF Bond Account No. Amount $ Terms of Contract Purpose/Description Project Closeout n Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) Required For Change Orders Only - Amount of E] increase $ M Decrease $9,571.50 Previous Amount $ 117,033.00 Current Percent of Change: 8.18 % New Amount $ 107,461.50 Total Percent of Change: 7.23% Copy Original E F-1 Roger Nawrot M F-1 Toy Villa � El