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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/13/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 03/27/2018 Phone Extension 5,920 <br />Required, Prior to Submittal to, Board, <br />Legal El Attorney Name: <br />Controller F] Controller review is required for all Contracts $5,0100.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />Agreement Amendment <br />Professional Services <br />Bidl Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Contract <br />Resolution <br />Bid Award <br />mmo. NEEMME =0 <br />E] Req. to Advertise El Title Sheet <br />um <br />J.L, Milling, Inc. <br />F1 Yes 0 No E] If Yes, Approved by <br />Purchasing <br />❑ MBE [J WBE <br />0 No El Yes Name of Company <br />2017 Cold Milling <br />117-051 <br />LRSA <br />251.0608.431.36.10 <br />Project Closeout <br />EJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ increase $ <br />Decrease 11 $,070.41 , <br />Previous Amount $ 62,200.00 <br />Current Percent of Change: 17.80% <br />New Amount $51,129.59 <br />Total Percent of Change: 17.80% <br />Copy Original <br />F-1 Kara Boyles, PhD, PE, City Engiinieer <br />Roger Nawrot, PE, PLS, Assistant City Engineer <br />F-1 Pete Kaminski, Manager of Streets' <br />