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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/17/2018 <br />Name Ky Department <br />Engineering <br />BPW Date 12/20/2018 Phone Extension 9083 <br />�imummmmmw�uumm . arw�uwmur»rvm wwouuuuuummmmmmmm�mmmuuuuuuuuuuuuuuuuuuuuuuuuuuuuwmmuuuuuuuuuuuumuuuumu�uwwwuwww,�wiu!xa�m�,n iommmmmmm�um�w�mwououwuuuiwiu�u�w�.w.w.uiuuwwwiuimuwwmm��� <br />.... _.. wire Prior to Submittal to Board_......___ _ ...._u....... _......w _....m <br />Legal Attorney Name Clara McDaniels <br />Controller E] Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing 0 Michael Schmidt <br />Check the <br />H Agreement <br />❑ Professional Services <br />E Bid Opening <br />Quote Opening <br />Change Order No. 5 <br />El Ease/Encroach. <br />Other: <br />iropriate Items eITIT <br />Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑], C/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />p _........ . <br />Pro osal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />❑ PCA <br />Company or Vendor Name Ziolkovwski Construction Inc.. <br />New Vendor E] Yes E No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor F MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Erskine Clubhouse Renovation <br />Project Number 116-108 <br />Funding Source VPA Maintenance Fund <br />................ww................_................................................... _........m................... <br />Account No. 2_�. <br />1.1101.452 39.89 <br />Amount......$.....1..421..4.............. <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran etc. <br />Required For Chartt Orders Onb <br />Increase $ 14,214 <br />Decrease $ <br />..... ---_ �... � ...�..... <br />Previous Amount $ 909,970 <br />Current Percent of Change: _1.56% <br />.... ...... <br />���� <br />New Amount $ 924,184.00 <br />Total Percent of Change: 1..�����- <br />9 <br />890 <br />Dispersal After Approval <br />Copy Original <br />® Kyle Silveus_ <br />® Patrick Sherman <br />................m,,,,,.............. <br />......... <br />