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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/2018 <br />Name Alicia Czarnecki/Toy Villa Department Enaineerin <br />................... . ..... ...... . . ............ . ............................ 9— <br />BPW Date 12/20/18 Phone Extension 5903 <br />�NHMMM�w <br />. ............ . . . ....... <br />..... . ...... Required Prior to Submittal to Board <br />............... ... . ..... . <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 Z Michael Schmidt <br />Check the A <br />LJ Agreement <br />F-1 Professional Services <br />F-1 Bid Opening <br />El Quote Opening <br />Z Change Order No. 1 <br />F-1 Ease/Encroach. <br />M Other--___ <br />Frorria"' ItemT p�q <br />y __ <br />Contract <br />ontract <br />M Resolution <br />El Bid Award <br />F-1 Quote Award <br />F-1 C/O & PCA No. <br />F-1 Traffic Control <br />for All Submissions <br />Proposal ---------- — 0 Addendum <br />0 Req. to Advertise E] Title Sheet <br />Required Information <br />Company or Vendor Name Martell Electric, LL <br />El PCA <br />New Vendor [:] Yes [:] No [] If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE [:] WBE <br />MBE/WBE Contractor Requested E] No 0 Yes Name of Company <br />Project Name Angela Bridge Lighh�tin.... ........ .......... <br />Project Number 116-111 <br />.................... . ..................... <br />Funding Source COIT <br />... . ........... .......... <br />Account No. 404-0602-431.22-40 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Provide andl install lights on the Angela Bridge <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc. <br />uired For Change Orders ON <br />Amount of Increase ' $__2,974-69 <br />Decrease $ <br />Previous Amount $49,022.00 <br />Current Percent of Change: 6.07% <br />New Amount $51,996.69 <br />Total Percent of Change: -.6.07% — ----- - <br />Dispersal After Approval <br />Copy Original <br />F-1 Kara Boyles <br />Alicia Czarnecki <br />El El <br />