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BOARD OF PUBIAC WORKS <br />AGENDA ITEM RE, VIEW RE QUEST FORM <br />Date .05/18/2018 . . ..... . Department Engineering <br />Name Toy Villa Division/Bureau DPW <br />BPW Date 06/12/2018 Phone Extension 5933 <br />Legal El 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 F <br />LJ Agreement <br />El Professional Services <br />F] Bid Opening <br />R Quote Opening <br />F-1 Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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 ❑ <br />F.Ar,•4 P 1% ITO <br />E] Req. to Advertise E] Title Sheet <br />I PAI 1 M <br />Selge Construction Co., Inc. <br />El Yes 0 No El If Yes, Approved Iby <br />MBE [:1 VVBE <br />❑ No H Yes Name of Company Martell mm <br />College Avenue & SunnVmede Avenue Traffic Calming <br />117-113 <br />M <br />251 .0608.431.42.96 <br />$37,400,00 <br />Project Closeout <br />U Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />El El <br />F-1 F-1 <br />El El <br />