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130ARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />09/13/2018 <br />Department <br />Public Wu arks <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />09/25/2018 <br />Phone Extension <br />5920 <br />Required Prior to Submittal to Board <br />Legal El 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 <br />Agreement Amendment <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />Contract Proposal L] Addendum <br />Resolution <br />d Bid Award Req. to Advertise ❑ Title Sheet <br />F-1 Quote Award <br />E] C/O & PCA No. PCA <br />F-1 Traffic Control: <br />New Vendor <br />MBEA/\IBE 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 H <br />El <br />Shambaugh & Sons, L.P. <br />El Yes E] No [] If Yes, Approved by <br />Purchasing, <br />[] MBE F] WBE <br />El No 0 Yes Name of Company <br />Century Center Fire Pump Replace rn" �en t <br />117-038 <br />Hotell-Motel Tax <br />7304.42010.000.0099 <br />$50,615.00 <br />ect Closeout <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 />Copy <br />Original <br />F-1 <br />F-1 <br />El <br />F] <br />