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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />08/27/2018 <br />Department <br />Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />09/1112018 <br />Phone Extension <br />59�20. <br />Legal El 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 ❑ <br />H Agreement H Contract H Proposal LJ Addendum <br />F-1 Professional Services El Resolution <br />n Bid Opening F] Bid Award F-1 Req. to Advertise F] Title Sheet <br />El Quote Opening EJ Quote Award <br />Change Order No, 5 n C/O & PGA No. ❑ PCA <br />Ease/Encroach. F-1 Traffic Control: <br />If Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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-1i <br />El <br />Walsh & Kelly, Inc. <br />El Yes M No E <br />Purchasing <br />[:] MBE [:] WBE <br />F-1 No El Yes Name of Comp <br />Downtown East-West Streetsca <br />117-041A <br />RWDA TIF <br />450.0405.453,36.01 <br />0 <br />Approval of C.O. #5 <br />If Yes, Approved by <br />es <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $31 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Changer <br />Copy <br />Original <br />❑ <br />K11 <br />$ 1,697,189.22 <br />1.86% <br />$ 1,728,726.22 <br />4.20% <br />Dispersal After <br />