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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /16/2018 <br />Name Toy Villa <br />Department Public Works <br />- .._..................— <br />Division/Bureau Engineering <br />BPW Date 11/27/2018 Phone Extension 5920 <br />.. .... <br />Required Prior to Submittal to Board <br />Legal❑ Attorney Name: <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 />_. <br />Check the ro riate Item T ie Requires for All Submissions <br />Agreement Amendment Contract Proposal Addendum <br />um <br />Professional Services Resolution <br />Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening Quote Award <br />[� Change Order No. C/O & PCA No. ® PCA <br />Ease/Encroach. Traffic Control: <br />f IOther: <br />Required Information <br />Company or Vendor Name <br />Premium Concrete Services, Inca <br />Yes Z No If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />..-.... _.............. .... <br />WB E <br />MBE/WBE Contractor Requested <br />ITIT ITITITITmmITITmmmmm <br />❑ No Yes Name of Company <br />�ITITmmXYmnMBE <br />Project Name <br />2018 Curb and Sidewalk Construction - Division B2 <br />. _._ .._� ............. <br />Project Number <br />118-007 <br />Funding Source <br />.. ........ ................. <br />MVH <br />Account No. <br />._.._........_ _ .... <br />202.0619.431.31.06 <br />Amount <br />w .................... <br />$36,160.00 <br />Terms of Contract <br />Purpose/Description <br />................. ._..._.......... ._....... <br />Project Closeout <br />............. <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of LJ Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: _ <br />New Amount $ <br />Total Percent of Chanee: <br />Copy <br />Original <br />El <br />❑ <br />uirl ed For C'ange Orders On <br />Disoemrsal After <br />Kara Boyles, City Engineer <br />._. ._.._ .. .............- <br />Marcia Qualls <br />