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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 4, 2018 <br />Name Roger Nawrot <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date December 11, 2018 Phone Extension 5932 <br />5555555��PMMPMMRIMIMIMIMIIMIIIIillillmlwwwm Mmffpl <br />Auired 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 H <br />Check the A <br />LJ Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />El Change Order No. <br />Ease/Encroach. <br />Other: <br />It <br />em tem Type - <br />Contract <br />''"-,—,-,— <br />F-1 Resolution <br />d for All Submissions <br />Proposal <br />Z Bid Award Req. to Advertise <br />F1 Quote Award <br />n C/O & PCA No, PCA <br />�El Traffic Control: <br />Required Information <br />F-1 Addendum <br />Z Title Sheet <br />Company or Vendor Name Brown & Brown General Contractors, Inc. <br />0 Yes E] No if Yes, Approved by <br />New Vendor Purchasina <br />MBE/WBE Contractor MBE F1 WBE <br />MBE[WBE Contractor Requested No 0� Yes Name of Com ny <br />Project Name Centumorry Center Lower North Restrooms Re air <br />Project Number -1 18-082A <br />Funding Source Liability Insurance <br />Account No. 226-0419-672.43-02 Code cc2018 <br />.......... <br />Amount $238, 638.00 <br />--- — — ­ - ----------- <br />Terms of Contract Not to Exceed <br />Purpose/Description Award Base Bid and Alternate No.1 <br />L] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />- --- - --------- ............ . . . ......... <br />. . ........ .. Req <br />Amount of !�ge Orders Only <br />El increase $ fired For Cha <br />E] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After <br />Copy Original <br />F-1 ❑ Chris Dressel <br />. ........... El El <br />El 11 <br />