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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />late 03/29/2018 <br />Name Joy Vi I I a Department Engineeni <br />BPW Date 04/10/2018 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal E] Attorney Name <br />Controller EJ 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 />NEEM � <br />F] Agreement r] Contract Ll Proposal ❑ Addendum <br />F-1 Professional Services E] Resolution <br />F-1 Bid Opening El Bid Award ❑ Req. to Advertise E] Title Sheet <br />❑ Quote Opening F] Quote Award <br />Change Order No. 1 C/O & PCA No. PCA <br />Ease/Encroach. ❑ Traffic Control <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />Ziolkowski Construction, Inc. <br />I l Yes IN No I I If Yes. Ar)r)roved by Purchasina <br />I iTI 1 0.1 a 0I ITITI 1.11 <br />0 No E] Yes Name of Comipany <br />2017 Engineerin Remodel <br />117-116 <br />Building & Street Maintenance <br />101.0602.431.36.01 <br />Approval of C.O. #1 <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non-Debarm�ent, E-Verify, Iran, etc. <br />Amount of M Increase $ 1,825.00 <br />El Decrease $ <br />Previous Amount $ 11,567.00 <br />Current Percent of Change: 15,78% <br />New Amount $ 13,392.00 <br />Total Percent of Change: <br />Copy <br />Original <br />1-1 <br />El <br />El <br />F <br />n <br />F <br />15.78% <br />Dispersal After Approval <br />