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BOARI) OF PUBLIC WORT <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />06/12/2018 <br />Department <br />Public Works <br />Name <br />Toy Villa -�7 <br />Division/Bureau <br />Engineering <br />BPW Date <br />06/26/2018 <br />Phone Extension <br />5920 <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 R <br />LJ Agreement Amendment <br />LJ <br />Contract LJ Proposal U Addendum, <br />F1 Professional) Services <br />El <br />Resolution <br />F-1 Bid Opening <br />F-1 Bid Award ❑ Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />F1 Quote Award <br />❑ <br />Change Order No. <br />F-1 C/O & PCA No,. Z PCA <br />Ease/Encroach. <br />El Traffic Control: <br />F-1 <br />Other: <br />Company or Vendor Name <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 />Amount of <br />El <br />C & E Excavating, Inc. <br />El Yes H No El If Yes, Approved by Purchasi <br />0 MBE 0 WBE <br />F-1 No El Yes Name of Company <br />York Road Sewer Repairs <br />115-139R <br />LRSA Capjtal Major Projects <br />251.0608.431.42.96 <br />$68,338.50 <br />Project Closeout <br />F-1 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: 0/0 <br />Dispersal After Approval <br />Copy Original <br />F-1 Kara Boyles,, City Engineer <br />F-1 Roger Nawrot, Assistant City Engineer <br />0 Ron O'Connor <br />