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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17, 2018 <br />Name ......B...�...�_�.�... .....�.....................�..0 <br />ecca Plantz <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 20, 2018 Phone Extension 5998WMWERM <br />..._.._ .__ .—........... <br />..�._ <br />Required Prior to Submittal to Board <br />Legal Attorney Name: mClara 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 R <br />Check the <br />El Agreement Amendment <br />D Professional Services <br />El Bid Opening <br />El Quote Opening <br />® Change Order No. 1 <br />❑ Ease/Encroach. <br />M Other: <br />�ropriate Item Type — <br />R Contract <br />❑ Resolution <br />❑ Bid Award <br />M Quote Award <br />❑ C/O & PCA No, <br />El Traffic Control: <br />uired Information <br />Company or Vendor Name <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 />for All Submissions <br />Proposal <br />Req. to Advertise <br />El PCA <br />Addendum <br />❑ Title Sheet <br />Terms of Contract Hours Not to ExceedLump Sum..m............�.��_�_�..........._........�............................................�....................mm.....�. <br />Purpose/Description The cleaniM and ins ection of well #6 at the Olive Well Field. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change OrdersOnly� mm__....� ..�........... _..� <br />Amount of Increase $ 12,307.00 <br />Decrease $ <br />Previous Amount $ 50,930.00 <br />Current Percent of Change: 24% <br />New Amount $ 63,237.00 <br />Total Percent of Change: 24% <br />Disoersal After Aooroval <br />Copy Original <br />® ❑ Becca Plantz <br />