Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 05, 2018 <br />Name Roger Nawrot��� <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date November 13, 2018 Phone Extension 5932 <br />n�wwrrrnaun,�e^�umHUNIN�airverar M rrtivrery ro��� <br />. _ ... <br />Required Prior to Submittal to Board <br />Legal ElAttorney Name: Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the <br />[_J Agreement <br />Professional Services <br />E] Bid Opening <br />El Quote Opening <br />E] Change Order No. <br />El Ease/Encroach. <br />Other: Amendment No. 2 <br />iropriate Itempe — <br />El Contract <br />Resolution <br />F1 Bid Award <br />El Quote Award <br />El C/O &PCANo. <br />El Traffic Control: — <br />for All Submissions <br />] Proposal <br />❑ Req. to Advertise <br />uired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name <br />Earth Ex loration, Inc. <br />_No__""" <br />New Vendor <br />❑ <br />Yes <br />�� If YesmAaproved by Pur chasing_ <br />MBE/WBE Contractor <br />MBE WBE <br />MBE/WBE Contractor Requested <br />q <br />� <br />� <br />No'� Yes Name of Company, <br />Project Name <br />ProjectNumber <br />_ <br />__...1�17-047,_........................�....� �.......�..............,�.....�.�.�.................rw��...........�.�............�...........................�....... ���.�. <br />Funding Source <br />East TIF - 17 J031 <br />Account No. <br />_River �_.� ...m�..�..... <br />2 <br />Amount$ <br />_429-1050-460.31-0 <br />_ <br />600.00 ....................0—�..............�_........_��..............................._._.................................��..v� <br />Terms of Contract <br />...to....Exceed ..................... _�.mm......................._. <br />Not <br />Purpose/Description <br />t s di t.... onwk dunn t.........................__—�_............................. <br />This i amend men for ad ial or ...... ..... .....-.... g he design period <br />work with the Architect. The total contract price with this <br />amendment is $13„169.50, <br />Re uired Cone �� ��__������ q tractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />._._ _ ..... �..� ..� _..� _�_ ....�� <br />uir d For Chan . r ��ers Qnl r <br />_ro <br />Amount of ❑ Increase.._ <br />m _ _. <br />... <br />�.� mm.a �.� �......._ <br />Decrease <br />.... �........... <br />$ <br />Previous Amount <br />Current Percent of Change: �mm /o <br />New Amount $ <br />Total Percent of Change _ °���� <br />0 <br />D�p�rsal After Ap royal <br />�����a_.. �_... �............ <br />Copy Original <br />® ❑ Kara Boyles <br />❑ ❑ Roger Nawr�.._�,._ ..................�...........w <br />❑ ❑...........w�.--.�..w..—......�___....... °t. �_............�................ _�.................� <br />