Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01 /15/2019 Department Public Works <br />Name T..... �..��..._..........,� Y �m�....�...................._... <br />oy Villa_ f Division/Bureau Engineering <br />BPW Date 01/15/2019Phone Extension 5920 <br />mnu� mmmmmmm�92.9&x rem000000 uuuuuuuummmmmmmmmmmmmmmmM M mmmmmmmumWm ##= r <br />....�,�,..� ...._ _.._____..� ....W.,.................... __ ............. ........ _W.W. <br />Required 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 themm <br />l_.-.IAgreement <br />D Professional Services <br />Bid Opening <br />El Quote Opening <br />F] Change Order No. <br />❑I Ease/Encroach. <br />F-1 Other: <br />iropriate Item Type — fe <br />_,quired for All Submissions <br />El Contract .... <br />E] Resolution <br />❑] Bid Award ❑, Req. to Advertise <br />Quote Award <br />® C/O & PCA No. 1 Final ❑ PCA <br />❑ Traffic Control: <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 />Terms of Contract <br />Required Information <br />Walsh & Kell m Inc. _ <br />_.... _ <br />❑ Yes F1 No ❑ If Yes, Approved by Purchasin <br />Addendum <br />❑ Title Sheet <br />MBE WBE <br />�] NoMarriott Hotemm -S' Yes Name of te p at Hall of Fame Phase 3 Compuw <br />117-064 <br />RWDA TIF <br />324.1050.460.42.01— mDivision Cw <br />Purpose/Description Proiet Closeout. _ ctor' s ❑, Required Contra s Certification FormAttached _ (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.............. ...m m. <br />Required For Chang Orders Only ___...._ <br />Amount of Increase $ ... w <br />® Decrease $ 5,138.16 <br />Previous Amount $ 438,711.32 <br />Current Percent of Change:_....._117%.�.�.�.�......_��_�.�.....mwW��._ ..... ..�_........._.._..�..................vv .,�.m <br />New Amount 4337 <br />Total Percent of Chan e. _ _ mm 17% -1 ���� �����............ _. �m,_............ �w�� <br />.. <br />Dispersal After A r rovaI <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />