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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />Date 08/01/2018 Department Public Works <br />Name Toy Vil'la. Division/Bureau Engineering <br />BPW Date 08/14/20118 Phone Extension 5920 <br />. . . . .. ...... <br />Required Prior to Submittal to Board <br />Legal F-1 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 />[J Agreement Amendment <br />E] Contract Ll Proposal Ll Addendum <br />F-1 Professional Services <br />F Resolution <br />F Bid Opening <br />El Bid Award El Req. to Advertise ❑ Title Sheet <br />F-1 Quote Opening <br />❑ Quote Award <br />Z Change Order No, 1 <br />❑ C/O & PCA No. ❑ PCA <br />E] Ease/Encroach. <br />F-1 Traffic Control: <br />F-1 Other: <br />Company or Vendor Name Shambaugh & Sons, L.P. <br />El Yes ❑ No F-1 If Yes, Approved by <br />New Vendor Purchasing <br />MBENVBE Contractor F1 MBE E] WBE <br />MBEANBE Contractor Requested F] No F] Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Century Center Fire Pump Replacement <br />117-038 <br />Hotel -Motel Tax <br />7304A2010.000.0099 <br />Add Flow Switch <br />0 Required Contractor's Certification Forms Attached (Nan - <br />Collusion, Nan -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Previous Amount $ 49,965.00 <br />Current Percent of Change: 1.30% <br />New Amount $ 50,615.010 <br />Total Percent of Change: 1.30% <br />Copy <br />Original <br />1-1 <br />El <br />El <br />R <br />El <br />R <br />