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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW RE, QUEST FORM <br />Date 09/18/20 18 <br />Name Toy Villa Department Engine�enng <br />BPW Date 09/25/2018 Phone Extension 5920 <br />RequiredPrior 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 El Michael Schmidt <br />El Agreement ❑ Contract L] Proposal U Addendum <br />F-1 Professional Services El Resolution -1 Title Sheet <br />R Bid Opening Ell Bid Award E] Req. to Advertise F <br />F] Quote Opening F-1 Quote Award <br />❑ Change Order No. I R C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. F-1 Traffic Control <br />❑ Other: <br />Re uired Information <br />Company or Vendor Name Selge Construction, Inc. <br />New Vendor [:1 Yes M No El If Yes, Approved by Purchasing <br />MBEs BE Contractor ❑ MBE [:] WBE <br />MBENVBE Contractor Requested El No El Yes Name of Company <br />Project Name LWW Charles Martin Intersection Im <br />Project Number 1 17-072A <br />Funding Source RWDA <br />Account No. 324-1050-460-42.03 <br />Amount $ 1,131,012.15 <br />Terms of Contract <br />Purpose/Description Approval of C.O. #1 <br />rovements <br />F] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of 0 Increase $29,097.29 <br />E] Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />F-1 <br />El <br />11 <br />El <br />El <br />$ 1,131,012.15 <br />2.57% <br />$ 1,160,109.44 <br />2.57% <br />Dispersal After Approval <br />