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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/06/2018 <br />Aida za n......._S.0 n Doudrick Department Engineering <br />Name Alicia Czarnecki/Sue Ellen <br />BPW Date 11/13/2018 Phone Extension 5903 <br />...... <br />_�..�....�............ Legal .. <br />Fquired Prior to Submittal to Board _ <br />® Attorney Name Clara McDaniels _...m................ <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 />Check the—, <br />Agreement <br />El Professional Services <br />Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />n Other: <br />Michael Schmidt <br />Item Tvoe — <br />" Contract <br />Resolution <br />El Bid Award <br />Quote Award <br />❑ C/O & PCA No. <br />® Traffic Control <br />Company or Vendor Name TBD <br />r All Submissions <br />Proposal <br />® Req. to Advertise <br />uired Information <br />❑ PCA <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name McKinlet' Avenue and Fremont Park Improvements <br />Project Number 118-072 <br />Addendum <br />® Title Sheet <br />LRSA Utility Expense Contractual Service Fund / VPA (max <br />Funding Source $25q,000w00 � ...,. �a ��...�....... ......�.�.....,m <br />Account No. 251.0608.431.4................. <br />Amount TBD <br />---------- <br />—_._....—,,,,,,,,,,,,,,,,,,,,,ww......,--- � ........... --------- <br />.....................,.,.,.,.�.� <br />Terms of Contract TBD <br />Purpose/Description <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, on -Discrimination„ Non Debarment, , Iran„ etch <br />Required For Charue Orders O� _... <br />Amount of <br />El increase <br />F] Decrease <br />t <br />Previous Amount $ <br />............ ................. <br />Current Percent of Change: <br />New Amount <br />_.___ .............ww _n.. ................. <br />Total Percent of Change: % �~ <br />�. ............. ........... <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kara Boyles <br />❑ <br />❑ ���.wm ........_. <br />El <br />