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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 13, 2018 Department Public Works <br />�. _..._....... ........... <br />Name Theresa E. Harrison, P.E. Division/Bureau Engineering <br />BPW Date December 20, 2018 Phone Extension 5661.....................�......................w_ ....._ <br />elf(M9IA13�WMV11W]'d'IWM.9VW'!f'AVP9WIfMNNMNIWdNWNPpNNJttVNMiWMdNIdPV d 9�Pi pNJW&NI�A�MIdIMIMIMI <br />.—.w... ..,.�. .,. ..,..,. ...... .,.mm..,.m...,.m..m..................................... .....�,��„�,,,,.. <br />............ ._..-..... ired Prior to Submittal to mBoard <br />Legal Z Attorney Name: Clara McDaniels <br />Controller z 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 />Check the <br />❑I Agreement Amendment <br />F] Professional Services <br />[:] Bid Opening <br />❑ Quote Opening <br />-1 Change Order No. <br />Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />►date Item Type <br />F1 Contract <br />❑ Resolution <br />❑ Bid Award <br />® Quote Award <br />❑ C/O &PCANo. <br />_ <br />❑ Traffic Control: <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 />for All Submissions <br />8 Proposal <br />❑ Req. to Advertise <br />uired Information <br />Walsh. &. Kelly, Inc. <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />El Yes F1 No El If Yes, Approved by <br />Purchas1!!U ......._.. ._... m........... ... � � <br />MBE F-1 WBE <br />No 0 Yes Name of Compan <br />East Longfellow <br />Avenue & North Riverside Drive Traffic Calming <br />118-113 <br />LRSA Capital Ma or Pro ects f <br />�..A. <br />........P j jorTraffic Calming Devices <br />251-0608-431.42-96 <br />$72,850.00 <br />— ................. _ ............ ....... <br />Com letion date: June 15, 2019 <br />N Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />red For Chance Orders On <br />Amount of Increase <br />Decrease $ <br />Previous Amount $ <br />