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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />8/7/18 <br />Department <br />Public Works <br />Name <br />Kyle Silveus <br />Division/Bureau <br />Engineering <br />BPW Date <br />8/14/2018 <br />Phone Extension <br />9083 <br />1-0 I I 1 "10 H I me - a M0 Kq re ra I M MI "If <br />Legal F1 Attorney Name: Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the <br />LJ Agreement <br />F-1 Professional Services <br />0 Bid Opening <br />F-1 Quote Opening <br />[:] Change Order No. <br />El Ease/Encroach. <br />F1 Other: <br />TqpiaLeItem Type� <br />F-1 Contract <br />El Resolution <br />El Bid Award <br />F-1 Quote Award <br />[:1 C/O & PCA No. <br />F-1 Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />uired Information <br />10 F1.111 <br />for All Submissions <br />I Proposal <br />INIM <br />Addendum <br />0 Title Sheet <br />01 Yes El No 0 If Yes, Approved by Purchasing <br />[:] MBE [:] WBE <br />_E] NoEl Yes Name of Company <br />Lincoln Way East Corridor Improvements - Phase I <br />117-055A <br />RWDA TIF <br />324-1050-460-31-02 <br />$TBD <br />Base Bid <br />Purpose/Description Phase 1 Construction <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non-Debarmenit, E-Verify, lran, etc.) <br />Required For Change Orders Only <br />Amount of F-1 increase $ <br />[:] Decrease $ A.PL) <br />Previous Amount $ B"ard Of Pull Work,4 <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Chance: <br />Dispersal After Amroval <br />Copy Original <br />F] 1-1 <br />0 <br />