Change Order No 2-PCA- Jefferson & Twyckenham Signal Improvements Project No 116-027 - Martell Electric LLC

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 11 /16/2018 Department Public Works Name Toy Villa Division/Bureau Engineering BPW Date 11 /27/2018 Phone Extension 5920 immmmmmmmmmmuuummmmm ammmmuaa¢�mmvvvmmm ,.��....... ...........�, .. ._ . -------------- ._ _�.�.�..�.�..— Roquired Prior to Submittal to Board ....— __ ..._.._ ..__ ......... ._ Legal] Attorney Name: Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing F] Check the A E] Agreement ] Professional Services ❑ Bid Opening ❑ Quote Opening E] Change Order No. ❑ Ease/Encroach. Other: pro riate Item Typemm Re ar; ...... F.1 Contract ❑ Resolution �j Bid Award Quote Award C/O & PCA No.2 Final F-1 Traffic Control: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description for All Submissions Proposal ❑ Req. to Advertise Required Information Martell Electric, LLC ❑ PCA Addendum ❑ Title Sheet ,.E1 Yes Z No ._..... F] If Yes, Approved b Purchasing MBE � WBE _......_.... Yes ............_ -- ........ Nam .. No e of Comp Jefferson and Twyckenham Signal Improvements 116-027 LRSA M TO- _w wwwwwww_ 251.0608.431.42.96 Proiect Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination Non -Debarment„ E-Verif , Iran, etc. Amount of required For ChangeOrders ❑ Increase $ ® Decrease $ 1,466.54 Previous Amount $ 21-8,4 .4- 18,403.47 Current Percent of Change: 0.67% New Amount $ 116,936.93 0 _Total_Percent of Charge 10.03 /o .........w.....w Dispersal After Approval Copy Original ® ❑ Roger Nawrot ® Toy Villa