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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 18, 2018 <br />Name Roger Nawrot <br />Department Public Works <br />BPW Date December 20,2018 Phone Extension 5932 <br />_ ._......... _. <br />.._..........�........-..-._ <br />Required Prior to Submittal to Board <br />Legal <br />Attorney Name <br />Controller (❑ <br />Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing (� <br />Check .the....A .. ro riate Item T .._ 1ec�re_"w _ <br />for All Submissions <br />[� <br />Agreement <br />g <br />.��..........�......�w�. <br />El Contract F Proposal ddendum <br />EJ <br />Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® Bid Award ❑ Req. to Advertise ® Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />Traffic Control <br />El Other: <br />Required Information <br />Company or Vendor Name <br />D.C. Borers Co./Detroit Inc. <br />New Vendor <br />Yes No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑MBE <br />❑ WBE <br />MBE/WBE Contractor <br />Requested <br />El No El �... Yes...........Name ofCompan.........w....... <br />Project Name <br />Main & Colfax Parking Structure Repairs 2019 <br />Project Number <br />115-143A <br />Funding Source <br />g <br />Major Moves Gara a Fund andRWTIF <br />J <br />Account No. <br />mm.. _... <br />401-0401 415.36-01 and 324-1 , 19 <br />ro ect o e 15 0 <br />Amount <br />$866,370.00 <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />Major Moves Garage Fund $570,000.00 and RWTIF 296 370.00 <br />0 Required Contractor's Certification Form Attached (Non- <br />Collusion,Non-Discrimination, Non -Debarments E-Verify, Iran etc. <br />Required For Changg Orders Only____ ,,, <br />El <br />Amount of <br />E] <br />Increase $ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change, <br />...... ... ..._________W__ _,...m ..... <br />%o <br />New Amount <br />$ .. _ <br />Total Percent of Change: <br />_.......... <br />/o <br />Dispersal After Approvalmmm <br />Copy Original <br />M ❑ <br />..... <br />El El <br />.......................................................................................r <br />