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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />06/01112018 <br />Department <br />Public Works <br />Name <br />To Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />06/12/2018 <br />Phone Extension <br />5920 <br />Required Prior to Submittal to Board <br />Legal ❑ 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 El <br />H Agreement Amendment <br />H Contract LJ Proposal LJ Addendum <br />R Professional Services <br />❑ Resolution <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />❑ <br />Quote Award <br />Change Order No. 1 <br />❑ <br />C/O & PCA No. F] PCA <br />F-1 Ease/Encroach. <br />❑ Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBEAIVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />C & E Excavating, Inc. <br />[:] Yes Z No El If Yes, Approved by Purchasing <br />F-1 MBE F-1 WBE <br />I I No II I Yes Name of Comr)anv <br />York Road': Sewer Repairs <br />115-139,R <br />LRSA Capital Major Projects <br />251.0608.431A2.96 <br />I of C.O. #1 <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of Increase $4,950.00 <br />0 Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chance: <br />Copy <br />Original <br />M <br />F-1 <br />N <br />11 <br />$68,338.50 <br />7.81 % <br />Kara Boyles, City Engineer <br />Roger Nawrot, Assistant City Engineer <br />