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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 16, 2018 <br />Name Roger T. Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />❑ Agreement <br />❑ Contract ❑ Proposal L Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control• <br />I -I Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />MBEIWBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Walsh & Kelly <br />❑ Yes ® No <br />Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Comr <br />Downtown East-West Streetsc <br />117-041 A <br />RWTD <br />324-1050-460.3102 <br />$1,659,060.60 <br />If Yes, Approved by <br />es <br />Terms of Contract Not to Exceed <br />Purpose/Description Award Divisions A & B. Reject the Deductive Alternate. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />