Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/02/18 Department Public Works <br />❑ Agreement Amendment <br />U Contract U Proposal LJ Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />f l Other: <br />Company or Vendor Name <br />VS Engineering, Inc. <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested <br />No ❑ Yes Name of Company <br />Project Name <br />_❑ <br />Sewer and Manhole Rehabilitation <br />Project Number <br />118-093 <br />Funding Source <br />Utility Expense/Contractual Service <br />Account No. <br />641-0621-792.63-35 <br />Amount <br />$79,430,00 <br />Terms of Contract <br />Lump Sum for design, HNTE for construction <br />Purpose/Description <br />Design and construction of sewer and manhole rehabilitation for <br />various locations <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Re <br />aired For Chan` e Orders Ohl <br />Amount of ❑ Increase $ <br />❑ Decrease <br />$ <br />Previous Amount $ <br />Current Percent of Change: <br />% <br />New Amount $ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />0 <br />