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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/22/2018 <br />Department Public Works <br />NameToy Villa <br />Division/Bureau Engineering <br />BPVV Date 07/10/2018 <br />Phone Extension 5920 <br />Required Prior toSubmittal tdBoard <br />Legal F-1 <br />Attorney Name: <br />Controller El <br />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 ❑ <br />"h ock, the App <br />priot o Item Typo - Peguir <br />` <br />odfi or A11,S—, u bmh�slon <br />El Agreement Amendment <br />El Contract <br />Proposal El Addendum <br />F] Professional Services <br />F-1 Resolution <br />Bid Opening <br />n Bid Award <br />El Req. to Advertise El Title Sheet <br />❑ Quote Opening <br />n Quote Award <br />El Change Order No. <br />F] C/O & PCA No. <br />PCA <br />F-1 Ease/Encroach. <br />El Traffic Control: <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />M�BEA/\IBE 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 H Increase <br />[-] Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />F-1 <br />El <br />1:1 <br />Dynamic Mechanical Services, Inc.. <br />[:1 Yes Z No [:] If Yes, Approved by Purchasing <br />MBE [:] WBE <br />El No El Yes Name of Company <br />Langlab HVAC Improvements <br />117-024 <br />RWDA <br />324.1050,460.42.01 <br />$75,831.00 <br />Project Closeout <br />F1 Required Contractor's Certification Forms Attached (Non- <br />ColIusion, Non -Discrimination, Non -Debarment, E-Verify, lran, etc. <br />