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Date <br />Name <br />04/13/2018 <br />Toy Villa <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REA QUEST FORM <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 04/24/2018 Phone Extension 59,20 <br />R e q u,ired Prior to Submittal to Board <br />Legal F-1 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 n <br />�[-] Agreement <br />LJ Contract H Proposal LJ Addendum <br />E] Professional Services <br />F-1 Resolution <br />R Bid Opening <br />El Bid Award E] Req. to Advertise ElTitle Sheet <br />E] Quote Opening <br />F-1 Quote Award <br />H Change Order No. 4 <br />F1 C/O & PCA No. ❑ PCA <br />F-I Ease/Encroach. <br />E] Traffic Control: <br />Other: <br />Company or Vendor Name <br />New Vendor <br />BE/BE 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 />Selge Construction . ..... <br />El Yes 0 No El If Yes, Approved by Purchasing <br />E]-MBE, [] WBE <br />0 No L1 Yes Name of Company <br />Western Avenue Corridor Improvements from Bendix Drive to <br />Olive Street <br />115-097 (16JW01) <br />RWDA T'IF <br />324.1050.460.42,.,03 <br />Approval of C.O. #4 <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of El Increase $2,338.53 <br />F-11! Decrease $ <br />Previous Amount $ 2,860,242.15 <br />Current Percent of Change: 0.08% <br />New Amount $ 2,862,580.68 <br />Total Percent of Change: 5.50% <br />Copy <br />Original <br />El <br />E] <br />F <br />❑ <br />