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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1!0/08/2018 Department <br />Name Toy Villa Division/Bureau <br />BP W Date 10/23/2018 Phone Extension <br />Public Works <br />Engineering <br />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 />Agreement Amendment <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. 1 <br />Ease/Encroach, <br />Other: <br />Company or Vendor Name <br />" Contract LJ Proposal LJ Addendum <br />F-1 Resolution <br />mid Award El Req. to Advertise ❑ Title Sheet <br />Quote Award <br />El C/O & PCA No. PCA <br />F] Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBEAA/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 />Ziolkowski Construction, Inc. <br />El Yes 0 No E] If Yes, Approved by <br />Purchasing <br />[:1 MBE [:1 WBE <br />El No El Yes Name of Company <br />Fire Station #9 <br />mm <br />11 16-012 <br />2018 Fire Station #9 Capital <br />451.0901.422.42.02 <br />Approval of C.O. #1 <br />F Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment, E-Verifv, Iran, etc. <br />Amount of F-1 increase $ - <br />M Decrease $ 9,166.00 <br />Previous Amount $ 3,652,500.00 <br />Current Percent of Change: 0.25°1® <br />New Amount $ 3,643,334.00 <br />Total Percent of Change: 0.25% <br />Copy <br />Original <br />F-1 <br />El <br />El <br />Steve Cox <br />Todd Skwarcan <br />