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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE, QUEST FORM <br />Date 04/17/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 04/24/2018 Phone Extension 5920 <br />...... . .... . . . ..... <br />Reauired Prior to Submittal to Board <br />Legal E] 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 ❑ <br />❑ Agreement <br />[_1 Contract H Proposal Ll Addendum <br />❑ Professional Services <br />F Resolution <br />F__1 Bid Opening <br />F-1 Bid Award El Req. to Advertise El Title Sheet <br />F] Quote Opening <br />Quote Award <br />Z Change Order No. I <br />❑ C/O & PCA No. ❑ PCA <br />0 Ease/Encroach. <br />F-1 Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />El <br />Martell Electric, LLC El Yes No ❑ If Yes, Approved by Purchasing <br />X <br />=MBE [:] W13_E <br />F-1-No [:] Yes Name of Company <br />Jefferson and Twyckenham Signal Improvements <br />116-027 <br />LRSA-Major <br />251.0608,431.42.96 <br />Approval of C.O. #1 <br />[:] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $21,246.00 <br />Decrease $ <br />Previous Amount $ 197,157.47 <br />Current Percent of Change: 10.78% <br />New Amount $ 218,408.47 <br />Total Percent of Change: Y 10,78% <br />Copy <br />Original <br />❑ Roger Nawrot <br />❑ Toy Villa <br />