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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST" FORM <br />Date 05/15/2018 <br />Name _K �le S�i veus Department Engineering <br />BPW Date 05/22/2018 Phone Extension 5601 <br />. .. . . ..... <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name Clara McDaniels <br />Controller o Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the Appropriate Item Type - Required for All Submissions <br />El Agreement F-1 Contract Proposal El Addendum <br />El Professional Services F Resolution <br />F-1 Bid Opening F Bid Award Z Req. to Advertise El Title Sheet <br />F-1 Quote Opening E] Quote Award <br />❑ Change Order No. F C/O & PCA No. F-1 PCA <br />Ease/Encroach. F-1 Traffic Control <br />F-1 Other: <br />Required Information <br />Company or Vendor Name <br />TBID <br />New Vendor <br />❑ Yes [] No E] If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />❑ MBE F-11 WB,E <br />MBENVBE Contractor Requested [:] No R Yes Name of Company <br />Project Name <br />Erskine Clubhouse Renovation <br />Project Number <br />116-108 <br />Funding Source <br />SS TIF <br />Account No. <br />430-1050-460-42.02 <br />Amount <br />$ TBD <br />Terms of Contract <br />Base bid with alternates <br />Purpose/Description <br />Renovation of clubhouse at Erskine Golf Course <br />E] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of El increase $ <br />EJ Decrease $ &P.P40vu) <br />Previous Amount <br />Jot&t <br />Current Percent of Change: <br />% MhV r) I I)MA /1 <br />New Amount <br />$ V s <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />R F-1 <br />F-1 El <br />El El <br />