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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />Date 03/29/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 04/10/2018 Phone Extension 5920 <br />Legal F-1 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 Amendment <br />H Contract LJ Proposal H Addendum <br />E] Professional Services <br />F Resolution <br />F-1 Bid Opening <br />El Bid Award E] Req. to Advertise ❑ Title Sheet <br />F Quote Opening <br />[:] Quote Award <br />F-1 Change Order No. <br />D C/O & PCA No. PCA <br />F Ease/E,ncroach, <br />F-1 Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE 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 />Walsh & Kelly, Inc. <br />El Yes N No El If Yes, Approved by Purchasi <br />MBE M WBE <br />No [:] Yes Name of Company <br />East Bank Sewer Separation — Phase V <br />114-062B <br />REDA TIE and 2012 Sewer <br />429,1050.460.31.02 <br />$5,511,798.78 <br />Approval of Completion Affidavit <br />[] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of El increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Chanae: <br />Copy <br />Original <br />F-1 <br />El <br />El <br />F-1 <br />El <br />El <br />