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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/03/2018 Department Public Works <br />Name .......Kyle ..�S.�il�ve...u_s............��� ......................�...����� �.�.�.......................Division/Bureau Engineering B�ering --- <br />-._.......... <br />BPW Date12/11/2018...............���....��� <br />Phone Extension 9083 <br />ww.uu�w�dimrimanmmw�wwmrauwuwmwwveiom�aniuwoioioioioioi�mw � vaaavrmm�nnnrd�mrmuwuum�muuuuuuuuuummmmumumumwwwuwimmmmmmuwimuwimmmuwimmmmw�r�rwua�r wmruur�a�w�w�m�w�u�� mumamu+�mm�remmawuorm�av � wrrm�u <br />...... �.. ................. ____..W_.... ,.............................� <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name: <br />Controller E] 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 E] <br />Check the <br />Agreement <br />❑ Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. 1 <br />Ease/Encroach. <br />l � Other: <br />fro riate Item.T.o - <br />❑I Contract <br />❑ Resolution <br />El Bid Award <br />E] Quote Award <br />❑ C/O & PCA No. - <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 />d for All Submissions <br />m...-......._.. <br />Proposal <br />❑ Req. to Advertise <br />Required Information <br />❑ PCA <br />Walsh & Kelly, Inc. O1 <br />m _Yes,A roved b <br />❑ Yes ENo❑If _. y Purchas i <br />❑ MBE [:] WBE-- <br />No 0 Yes Name of Company <br />Lincoln Wa East Corridor Imp roveme ... O1 <br />117-055A <br />Park Bond E, RW TIF Bond <br />471-1134-452.42-01, 452-1101-452.31-06 <br />40 $59,00.00................... <br />Approval of C.O. #1 <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination Non -Debarment, E-Verify, Iran, etc. <br />_._._____�_.�_,_A m. �..................._ Required For Chan Orders Only ...mm_ ....... _ ..m.. <br />Amount of ® Increase $ 16,385.00 <br />Decrease $ <br />Previous Amount $ 459,000.00 <br />Current Percent of Change: 3.......:.. � w <br />g _5 7 °�a.�.�.�.�.�.......... -- - <br />New Amount $ 475,385.00 <br />.. <br />Total Percent of Change: 3.57%...._�... . . ................................................................. <br />mw�...��... _,m.....��.�...�................................_�...��a_ <br />Copy <br />Original <br />El <br />11 <br />❑ <br />El <br />