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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 14, 2018 <br />............................ <br />Name Scott Kreeger <br />Purchasing ® Michael Schmidt <br />Check the <br />Agreement Amendment <br />E' Professional Services <br />Bid Opening <br />[ Quote Opening <br />F] Change Order No. <br />E] Ease/Encroach. <br />F-1 Other: <br />iropriate Item Type — <br />F1 Contract <br />I-1 Resolution <br />Department Public Works <br />WDivision/Bureau Engineering <br />for All Submissions <br />] Proposal <br />❑ Bid Award ❑ Req. to Advertise <br />® Quote Award <br />❑ C/O & PCA No. ❑ PCA <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 />Required Information <br />Ziolkowski Construction, Inc. <br />Yes N No LJ If Yes, Approved by Purchasi <br />MBE 0 WBE <br />_............ <br />No F ] Yes Name of Companv <br />Addendum <br />❑ Title Sheet <br />Engineering Office Improvements <br />118-107 <br />�.....__.... ..... ....... <br />BuildingMaintenance and Re airs <br />._........... <br />101.0602.431.36.01 <br />�.......................... <br />$7,800 <br />Lump Sum <br />13th floor ergi�neering office improvements and renovations <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Charade Orders i�ui <br />Amount of <br />El increase $ _.. <br />........... <br />E] Decrease $ <br />Previous Amount $ <br />------------- <br />Current Percent of Change: <br />New Amount _.$.............._...__ <br />Total Percent of Change: % <br />_. _ ...... <br />Dispersal After <br />Copy Original <br />® ❑ Kara Boyles <br />® ElToy Villa <br />