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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE' VIEW REQUEST FORM <br />Date 12/13/2017 <br />Name Sue Ellen Doudrick <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 12/21/2017 Phone Extension 5922 <br />Legal Z Attorney Name: Clara McDaniels <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 0 <br />LJ Agreement Amendment <br />LJ Contract LJ Proposal LJ Addendum <br />Professional Services <br />F-1 Resolution <br />❑ Bid Opening: <br />F Bid Award ❑ Req. to Advertise F-1 Title Sheet <br />F-1 Quote Opening <br />F Quote Award <br />El <br />Change Order No. <br />D <br />C/O & PCA No. El PCA <br />F-1 <br />Ease/Encroach. <br />❑ <br />Traffic Control: <br />F-1 <br />Other: General Release <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />LFA <br />M Yes El No F1 If Yes, Approved by <br />Purchasing <br />0 MBE El WBE <br />El No El Yes Name of Company <br />East Race Walkway Assessment & Repair <br />117-130 <br />Funding Source Fund 101 <br />Account No. - <br />Amount $16,500 <br />Terms of Contract East Race Trail inspection and repair (under Colfax Bridge) & <br />Purpose/Description structural assessment of retaining wall north of LaSalle <br />Fj 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-1 Increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />F-1 <br />F-1 <br />F-1 <br />11 <br />El <br />El <br />