Change Order No 1-PCA - Ziker Sample Street Bldg Restroom Remodel Project No 117-123 - Premier I Construction Inc

Home Browse Search

BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/04/18 Name Toy Villa ` Department Engineering BPW Date 12/11/18 Phone Extension 5920 N �" '�� N6/lMWNIIIIIIIIIYIYIYW WWNV.WNIP7INYPIWYW IY'w. .. .,w.�............... �........�......,.,........ mm.,.,�.,�....�..�....�.�,.......�................,-�.�.�.�....�..�.�..,�. Re.quired 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 Check the LJ Agreement ❑ Professional Services ❑ Bid Opening ❑ Quote Opening ❑ Change Order No. ❑ Ease/Encroach. F-1 Other: Company or Vendor Name New Vendor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description rro riate Item Type — Requi, [ Contract Resolution Bid Award ❑ Quote Award ® C/O & PCA No. 1 Final El Traffic Control for All Submissions ❑ Addendum ]'Proposal ❑ Req. to Advertise ❑ Title Sheet Required Information ❑ PCA Premier 1 Construction, Inc. __...-...wwwwww...ww MBE �] W � If Yes, Approved y Purchas — _---_B E Ziker Sample Street Building Restroom Remodel 117-123 River West TIF 324-1050-460-42.02 Project Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.. uired For Change Orders On El increase $ Amount of Decrease $ m3„7820 Previous Amount Current Percent of Change* 15.92...._�____..........._ New Amount $19��,��978.00�� Total Percent of Change: 15.92% Dispersal After Approval Copy Original ❑ ❑ ❑ ❑