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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 08/20/2018 Department Public Works <br />Name Toy Villa -,,"V Division/Bureau Engineering <br />BPW Date 08/28/2018 Phone Extension 5920 <br />.. . . . ....... .. . . ........ <br />required Prior to Submittal to Board, <br />Legal F] Attorney Name: <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 El <br />❑I Agreement <br />[J Professional Services <br />E] Bid Opening <br />F] Quote Opening <br />M Change Order No. 4 <br />❑I Ease/Encroach.. <br />F-1 Other: <br />Company or Vendor Name <br />U Contract L_J Proposal ❑ Addendum <br />F1 Resolution <br />R Bid Award El Req. to Advertise El Title Sheet <br />❑ Quote Award <br />C/O & PCA No. ❑ PCA <br />Traffic Control: <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 V \J <br />El <br />Walsh & Kelly, Inc. <br />El Yes M No F-1 If Yes, Approved by <br />Purchasing ._ <br />E] MBE ❑ WBE <br />E] No 0 Yes Name of Company <br />Downtown East-West Streetscapes <br />117-041A <br />RWDA TIF <br />324.1050.460.42.03 <br />Approval of C.O. #4 <br />E] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $25,250.62 <br />Decrease $ <br />Previous Amount $1,67 <br />Current Percent of Change: 1.51% <br />New Amount $ 11,69 <br />Total Percent of Change: 2.30% <br />Copy <br />Original <br />F-1 <br />❑ <br />E] <br />MOW <br />