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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REA VIEW REQUEST FORM <br />Date October 16, 2018 <br />Name Roger, Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPS/ Date October 23, 2018 Phone Extension 5932 <br />Re uired Prior to Submittal to Board <br />Legal Z Attorney Name-, Clara McDaniels <br />Controller z 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 z <br />Check the Appropriate Item Type - Required for Al! Submissions <br />F-1 Agreement F] Contract El Proposal 0 Addendum <br />F] Professional Services [:] Resolution <br />Bid Opening F-11 Bid Award Z Req. to Advertise Z Title Sheet <br />Quote Opening F-1 Quote Award <br />F-1 Change Order No. n C/O & PCA No. PCA <br />F-1 Ease/Encroach. n Traffic Control: <br />F1 Other: <br />Required Information <br />Company or Vendor Name <br />El Yes E] No El If Yes, Approved by <br />New Vendor Purchasing <br />MBEANBE Contractor M MBE E] WBE <br />MBEANBE Contractor Requested [:] No D Yes Name of Company <br />Project Name Century Center Lower North RestrooTs_�Re air <br />Project Number 118­082A <br />Funding Source <br />Account No. <br />Amount, <br />Terms of Contract <br />Purpose/Description <br />Liability Insurance <br />226-0419-,672.43-02 Code cc2018 <br />To be advertised on November 9 and 16 with the bid opening on <br />November 27. <br />E] Required Contractor's Certification Forms Attached (None <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of Fj increase $ <br />E] Decrease $ <br />Previous Amount 13oard $ <br />Current Percent of Change <br />New Amount <br />T <br />I'll, /'"J ­n' otal Percent of Change: % ;r_ T1 IL <br />I Dispersal After Approval <br />Copy <br />Original <br />F� <br />M <br />F <br />F-1 <br />El <br />El <br />Chris Dressel <br />