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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST' FORM <br />Date 06/04/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 06/12/2018 Phone Extension 5920 <br />R )quired Prior to Submittal to Board <br />Legal FJ 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 1:1 <br />H Agreement Amendment <br />[J Professional Services <br />E] Bid Opening <br />F-1 Quote Opening <br />F-1 Change Order No. <br />F-1 Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />LJ Contract <br />F-1 Resolution <br />❑ Bid Award <br />❑ Quote Award <br />Z C/O & PCA No. 1 Finall <br />D Traffic Control: <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 />wmENFA 0 -Tgr*M711 <br />o, TqTT <br />0 Req. to Advertise El Title Sheet <br />mom" <br />Ziolkowski Construction, Inc. <br />El Yes 0 No F1 If Yes, Approved by <br />Purchasing <br />E] MBE [-] WBE <br />[J No 0 Yes Name of Company <br />Century Center _qkyjqht Beams Painting <br />117-004 <br />Hotel - Motel <br />7304A2010.000.0099 <br />$118,759.22 <br />Protect Closeout <br />[:] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non-Discri rn i nation. Nan -Debarment. E-Verifv, Iran, etc. <br />Amount of Z Increase $2,990.00 <br />F-1 Decrease $ <br />Previous Amount $ 115,769.22 <br />Current Percent of Change: 2.58% <br />New Amount $ 118,759.22 <br />Total Percent of Change: 2.58% <br />Copy <br />Original <br />z <br />0 Tara Weigand <br />z <br />❑ Scott Herczeg <br />z <br />❑ Leanna Belew <br />