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Date <br />Name <br />J�1-; <br />Toy Villa <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW RE, QUEST FORM <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 03127/2018 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: <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 EJ <br />H Agreement <br />F] Contract El Proposal ❑ Addendum— <br />R Professional Services <br />R Resolution <br />F1 <br />Bid Opening <br />R Bid Award El Req. to Advertise E] Title Sheet <br />El <br />Quote Opening <br />F] Quote Award <br />M <br />Change Order No. 1 <br />[] <br />C/O & PCA No. ❑ PCA <br />R Ease/Enicroach�. <br />F-1 <br />'Traffic Control: <br />R Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />B.C. Mechanical, Inc. <br />El Yes E No El If Yes, Approved by Purchasing <br />F1 MBE 0 WBE <br />D No F1 Yes Name of Company_ <br />Studebaker Museum Rooftop Unit Replacements <br />117-081 <br />Liability Insurance <br />226.0417.672.39.011 <br />Changing of RTU's, <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran. etc. <br />Amount of ❑ Increase $ 573.00 <br />Decrease $ <br />Previous, Amount $ 157,000.00 <br />Current Percent of Change: 0.36% <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />1-1 <br />F] <br />F� <br />11 <br />E] <br />El <br />$ 157,573,00 <br />0.36% <br />