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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />Date 018/2018 <br />Name ToEngineeringDepartment Engineering <br />V-"(4 <br />BPW Date 01213/2018 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal 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 El <br />H Agreement <br />0 Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />Z Change Order No. 9 <br />F-1 Ease/Encroach. <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />LJ Contract H Proposal U1Addendum <br />El Resolution <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Award <br />C/O & PCA No. PCA <br />F-1 Traffic Control <br />Required Information <br />Walsh & Kelly, Inc. <br />-0—yes M No E] If Yes, Approved by Purchasing <br />1 1 MBE 171 WBE <br />[] No [:] Yes Name of Company _ <br />East Bank Sewer Separation - Phase 5 (Division B) <br />114-062 <br />REDA TIF and Other Contractual Services <br />429.1050.460.31,.02 ($8,921 M) <br />641.0630793.63.35 ($69,004,.65) <br />Approval of Final Change Order #9 <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of Z increase $ 77,926-118 <br />[:] Decrease $ <br />Previous Amount $ 5,433,872.60 <br />Current Percent of Change: 1.43% <br />New Amount <br />391M.T.-W.- <br />Total Percent of Change.- 8.48% <br />Dispersal After Approval <br />Copy Original <br />z F1 Judy Love, Beth Leonard <br />z R Roger Nawrot <br />z F-1 Toy Villa <br />