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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/18 <br />Name Sue Ellen Doudrick <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date 12/20/18 Phone Extension 5922 <br />N1WlJ1 W@ lkIIITNNNNl000011 GGGW IP�IWIWBYpIMII�WIAIMNNNPoFNNNWM.YIXM1MgNMONNIWffAI NNtl4�n5/NNMWNOIWM1'EI6 + // h%N/h 9 i�M.@.MIMVIWllIWI MMMEMN11111lllllllll111111II <br />required Prior to Submittal to Board <br />.�... ...._ . _ _ ...._...... ....... _.._ ............ ... ...�........... <br />Legal ❑ Attorney Name: Clara McDaniels <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing [❑ <br />Checkthe <br />Agreement Amendment <br />Professional Services <br />0 Bid Opening <br />[l Quote Opening <br />❑ Change Order No. <br />❑[ Ease/Encroach. <br />F1 Other: <br />Michael Schmidt <br />wogiiate Item'Type <br />0 Contract <br />❑ Resolution <br />® Bid Award <br />El Quote Award <br />El C/O & PCA No, <br />El Traffic Control: <br />�.�.... <br />or All Submissions <br />Proposal <br />[❑ Req. to Advertise <br />Required Information <br />[] PCA <br />Addendum <br />® Title Sheet <br />Company or Vendor Name <br />GE Marshall <br />® Yes ❑ No ❑ If Yes, A roved by <br />New Vendor <br />Purchasin <br />MBE/WBE Contractor <br />❑ <br />MBE WBE <br />MBE/WBE Contractor Requested <br />No ❑] Yes Name of Company <br />Project Name <br />Small Drainage <br />anage Des n and Repair w mm <br />mmmmm ��. <br />Project Number <br />118-063 <br />Funding Source <br />Utilitv Expense/Contractual Service Fund <br />Account No. <br />SSDA TIF for Hawbaker Division A ,..w <br />Amount <br />� �............ �....�.�................................................mm�__Y..................................����...�. <br />135,628.00 <br />Terms of Contract <br />...............ww.........,...............�.....................a— <br />Unit <br />nitric <br />pes <br />........................ ,. ... �� m.......�....................w�... ... _................. ..� <br />Drainage Improvements to 1) Olivia Circle 2) Creekwood Estates <br />Purpose/Description <br />ker Street <br />Required Contractors _....,,� � <br />qCertification Forms Attached ' Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />�. ----------- _..ww _ ........ .._ <br />Required For Change Orders Only <br />Amount of El <br />[❑ <br />Increase <br />Decrease <br />$ <br />$ <br />Previous Amount $ _ <br />Current Percent of Change: % <br />New Amount $ <br />