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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/24/20�18 Department --Public Works <br />Name Toy Villa ---rvl Division/Bureau Engineering <br />BPW Date 08/14/2018 Phone Extension 5920 <br />... ....... . <br />Required Prior to Submittal to Board <br />Legal ❑ 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 />F-1 Agreement Amendment ❑ Contract LJ Proposal LJ Addendum <br />F Professional Services ❑ Resolution <br />F Bid Opening D Bid Award ❑ Req. to Advertise E] Title Sheet <br />El Quote Opening El Quote Award <br />E] Change Order No. F-1 C/O & PCA No. PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />Other: <br />Company or Vendor Name <br />Edward J. White, Inc. <br />F1 Yes H No E] If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEANBE Contractor <br />F] MBE 0 WBE <br />MBE/WBE Contractor Requested <br />F-1 INo F] Yes Name of CompAn <br />Project Name <br />Century Center Vestibule Heater <br />Project Number <br />117-044 <br />Funding Source <br />Hotel -Motel Tax <br />Account No. <br />7304.42010.000.0099 <br />Amount <br />$34,150.74 <br />Terms of Contract <br />Purpose/Description <br />Project Closeout <br />Amount of F] <br />F] <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 Chancre: <br />Dispersal After Approval <br />Copy <br />Original <br />11 <br />F] <br />F-1 <br />El <br />El <br />E] <br />