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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />10/15/2018 <br />Patrick Sherman/ Alicia Czarnecki Department VPA <br />Purchasing <br />® Michael Schmidt <br />❑ Agreement U Contract U Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />�I Other: Amendment #1 <br />Company or Vendor Name KIL Architecture & Planning <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No EJ Yes Name of Company <br />Project Name Maintenance Storage Building <br />Project Number 118-046 <br />Funding Source Park Bond: Series I <br />Account No. 751-1101-452-39.89 <br />Amount $ 2,950.00, New Total $ 41,850.00 <br />Terms of Contract Lump Sum <br />Purpose/Description Increase for design changes for change order. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />