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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW laQUEST FORM <br />Date 05/15/2018 <br />Name _Toy Villa Department Engineering <br />BPW Date 05/22/2018 Phone Extension 5920 <br />. . . ...... ....... <br />ik�q_Tjred Prior to Submittal to Board <br />Legal F] 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 0 <br />H Agreement <br />[:] Professional Services <br />El Bid Opening <br />F-1 Quote Opening <br />F-1 Change Order No. <br />F-1 Ease/Encroach. <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Terms of Contract <br />Purpose/Description <br />r"%A V 1J <br />mount of El <br />LJ Contract <br />F-1 Resolution <br />F Bid Award <br />F-1 Quote Award <br />Z C/O & PCA No. 18 Final <br />El Traffic Control <br />um <br />III <br />Rieth-Riley Construction Co., Inc. <br />If Yes, Approved by Purchasing <br />F MBE F-1 WBE <br />El No El Yes Name of Company <br />South Bend One-Wav to Two-Wav Conversion <br />116-001 <br />Building & Street Maintenance <br />202-0607-431.36-01 <br />Project Closeout <br />0 Required Contractor's Certification Form Attached (Non- <br />Coliusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $52,935.93 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />❑ <br />El <br />$ 17,796,771.84 <br />$ 17,849,707.77 <br />10.65% <br />. = g S - ­ � I - R <br />