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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE VIEW REQUEST FORM <br />Date 09/11/2018 Department Public Works <br />Name Toy Villa,�� Division/Bureau Engineering <br />.7 <br />BPW Date 09/25/2018 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal F-1 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 />E] Agreement Amendment <br />LJ Contract Ll Proposal Ll Addendum <br />F_1' Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />0 Bid Award F] Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />El Quote Award <br />[:] Change Order No. <br />F-1 C/O & PCA No. PCA <br />El Ease/Encroach. <br />F-1 Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBE/' VBE 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 El increase <br />F-1 Decrease <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />B. C. Mechanical, Inc. <br />[J Yes Z No [:] If Yes, Apprq\T.d.....by Purchasing <br />E:1 MBE [:1 WBE <br />F-1 No El Yes Name of Company <br />Studebaker Museum Rooftop, Unit Replacements <br />117-081 <br />Liability Insurance Fund <br />226.0417.672.39.01 <br />$162,29&00 <br />Proiect Closeout <br />F-1I, Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non-Debarmient, E-Verify, Iran, etc. <br />Copy Original <br />F] Kara Boyles, City Engineer <br />F-1 Patrick Slebonick, Studebaker National Museum <br />❑ El <br />