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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />November 05, 2018 <br />Department <br />Public Works <br />Name <br />Roger Nawrot <br />Division/Bureau <br />Engineering <br />�...... <br />BPW Date <br />November 13, 2018 <br />Phone Extension <br />5932 <br />Required Prior to Submittal to Board <br />Legal 0 Attorney 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 />LJ Agreement <br />® Professional Services <br />❑ Bid Opening <br />E] Quote Opening <br />Change Order No. _ <br />F1 Ease/Encroach. <br />-1 Other: <br />)ropriate Item Type — <br />Contract <br />El Resolution <br />El Bid Award <br />n Quote Award <br />El C/O &PCANo. <br />_ <br />❑ Traffic Control:' <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount$ <br />Total Percent of Change <br />Copy <br />Original <br />® <br />❑ <br />uired Information <br />for All Submissions <br />C Proposal <br />Req. to Advertise <br />■' • <br />Addendum <br />❑ Title Sheet <br />Lochmuller Group, Inc. <br />EJ-yes R No El If Yes,_ Approved bv Purchasing <br />(- MBE F] WBE � <br />❑ No �] Yes Name of Company <br />................... .... W........ ..� <br />Howard ParkRedevelopment- Inspection <br />.......................... ---._ <br />117-047C <br />—Fund 407 ....................... �......�.................................�......�..........�..................�..............�..............�.................._..._.._.�......................................____ <br />_. _. _ _ m................................_._.._..............................................................................�............. <br />407-1101-452.31.06 <br />$ 520,200.00 <br />Not to Exceed <br />ime <br />tion <br />ion <br />This <br />Requi ed Cont actorltsCertificati ncForms Attates <br />Attached (Non <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Chanae Orders <br />Dispersal After <br />