Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />5/09/20118 <br />Department <br />Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />5/22/2018 <br />Phone Extension <br />5920 <br />. . ......... . <br />me <br />Controller <br />Purchasing <br />❑ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />❑ Attorney Name: <br />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 />El <br />ie Appropriate Item Type — Rqquireq for All Submissions <br />❑ Contract ❑I Proposal ❑] Addendum <br />❑ Resolution <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award <br />Z C/O & PCA No. 5 final) ❑ PCA <br />❑ Traffic Control. <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE 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 F-1 <br />❑I <br />Selge Construction Co., Inc. <br />El Yes Z No ❑ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />F-1--No ❑ Yes Name of Company <br />Western Avenue Corridor Improvements from Bendix Drive to <br />Olive Street <br />115-097 (16JW01) <br />RWDA TIF <br />324-1050-460-42.03 <br />Project Closeout <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc, <br />Required, For ChangbOrders, Only <br />Increase $ <br />Decrease $ 387 59 <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />1-1 <br />1:1 <br />$ 2,8162,193.09 <br />5,49% <br />