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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 12/18/2018 Phone Extension 5920 <br />mmuwmm'xamx i... „ iwimwuuwuw!wmwmmummvwwimmuwwim!.nonmimm.... �imraav�imnmimimimimmmmmmimimimi v� aimrmaw w�ww <br />Rewired Prior to Submittal to Board <br />Legal ❑ Attorney Name: <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 El <br />Check the , <br />j Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />Quote Opening <br />® Change Order No. 7 <br />❑ Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />+ro nate Item Type — <br />Contract <br />0 Resolution <br />❑ Bid Award <br />❑ Quote Award <br />F-1C/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 />I Proposal <br />❑ Req. to Advertise <br />uired Information <br />val of C.O. #7 <br />E PCA <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran„ etc. <br />Amount of <br />Required For Change Orders ON <br />Increase $ 25,159 95 <br />�j Decrease $ <br />PreviousAmount �......�.....1..ti..728.„.�726..22...............��._����.�...................................��............K��__......._�m..�.�.�..... <br />Current Percent of Change:. 1.46%����������������.......................................��� ���.��............�..............�...�� _.,�. <br />NewAmount $ 1,753,886.17-� ................""" �.0 ��������A.��.�.................................. _�.,........ <br />Total Percent of Change.: 5.72% <br />.. .......... <br />..... ,. ���._._�.��_.....� ....... <br />Discersal After A�nDroval <br />Copy <br />Original <br />❑ <br />❑ <br />1:1 <br />El <br />