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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 15, 2018 <br />Name Becca Plantz <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date November 27, 2018 Phone Extension 5998 <br />�w muu uwwwummumuummmwwumm wmmMommimm !rimmrmomom�u�w �rmmmrmn�r <br />Required Prior to Submittal to Board <br />Legal ® 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 ❑ <br />Check the <br />Lj Agreement Amendment <br />Z Professional Services <br />[] Bid Opening <br />El Quote Opening <br />[1 Change Order No. <br />[l Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />Topriate Item Type_.-. <br />El Contract <br />[l Resolution <br />El Bid Award <br />Quote Award <br />[� C/O & PCA No, <br />El Traffic Control: <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 />for All Submissions <br />I Proposal <br />F� Req. to Advertise <br />PCA <br />Required Information <br />m..eric n tructurepoint Inc.. <br />... a.._ ...................................... <br />❑ Yes ❑No <br />Purchasin <br />MBE [:] WBE <br />r No F Yes Name of Come <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by <br />_.......Century enter Up rades and Renovations <br />118-104 <br />............ <br />Hotel/Motel.... Tax Fund <br />................. __.... <br />7304.42010 000.0099 <br />$60,000.00 <br />Terms of Contract Not to Exceed <br />Purpose/Description To update the north end passenger elevator, renovate thenorth <br />end upper level restrooms, and renovate the sales, finance, and <br />mana ement office suites <br />.......�............. <br />.................................. Required <br />[ quired Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.... m_ <br />-Required For Chary e Orders <br />Amount of ❑ Increase ....... <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount ........................_...... <br />Total Percent of Change: <br />Dispersal After <br />Copy <br />Original <br />®El <br />Becca Plantz <br />