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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/27/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 10/09/2018 Phone Extension 5920 <br />Legal 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 <br />F-1 Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />F-1 Ease/Encroach. <br />n Other: <br />Company or Vendor Name <br />LJ Contract H Proposal LJ Addendum <br />F-1 Resolution <br />0 Bid Award ❑ Req. to Advertise El Title Sheet <br />F-1 Quote Award <br />El C/O & PCA No. PCA <br />El Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/BE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Walsh & Kelly, Inc. <br />El Yes Z No If Yes, Approved by <br />Purchases <br />L-1 MBE Ll WBE <br />El No El Yes Name of Company <br />Tucker Drive <br />116-118A <br />RWTD <br />324.1050.460.31.02 <br />$309,203.68 <br />Project Closeout <br />F-1 Required Contractor's Certification, Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc, <br />Amount of F increase $ . . ...... <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change-, % <br />New Amount $ <br />Total Percent of Change: % <br />06MIZ7104= <br />Copy <br />Original <br />F-1 <br />❑ <br />F-1 <br />1:1 <br />1:1 <br />El <br />