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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE'VIEW REQUEST FORM <br />Date 10/16/2018 <br />Name Toy Villa Department Engineering <br />BPW Date 10/23/2018 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 El <br />F1 Agreement F1 Contract H Proposal H Addendum <br />E] Professional Services F-1 Resolution <br />R Bid Opening F-1 Bid Award E] Req. to Advertise El Title Sheet <br />F-1 Quote Opening Quote Award <br />Z Change Order No. 1 ❑ C/O & PCA No. E] PCA <br />F-1 Ease/Encroach. F-1 Traffic Control <br />R Other: <br />Company or Vendor Name The Robert Henry Corporation <br />New Vendor 0 Yes E] No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor E] MB,E F] WBE <br />MBENVBE Contractor Requested F-1 No F1 Yes Name of Company <br />Project Name VPA Maintenance Storage Building <br />Project Number 11 8-046R <br />Funding Source Park Bond Series I <br />Account No. 471-1138-452.42-01 <br />Amount $ <br />Terms of Contract <br />Purpose/Description Approval of C.0, #1 <br />[:] Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of F-1 Increase $18,800.00 <br />El Decrease $ <br />Previous Amount $ 330,174.00 <br />Current Percent of Change: 5,69% <br />New Amount $ 348,974.00 <br />Total Percent of Change: 5.69% <br />Dispersal After Approval <br />Copy <br />Original <br />F1 <br />1:1 <br />R <br />F1 <br />