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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/14/2019 Department Public Works <br />.... <br />Name To <br />y <br />y ViIIa �� � Division/Bureau Engineering <br />BPW Date 01/22/2019 Phone Extension 5920 <br />................... .. <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name: Clara McDaniels _.�ww.._..........._..... <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 ❑ <br />Check the Appropriatew, Item Type — Required for All Submissions <br />❑ Agreement El Contract Proposal E Addendum <br />Professional Services ❑ Resolution <br />❑ Bid Opening Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />® Change Order No. 3 ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. El Traffic Control: <br />Other: <br />Required Information <br />Company or Vendor Name <br />Larson Danielson Construction Company Inc. <br />❑ Yes ❑ No El If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />q <br />No <br />❑ � Yes v Name of Comp pent' <br />Howard Park Redevelopment & St. Louis Boulevard <br />Project Name <br />Improvements <br />Project Number <br />117-047B <br />Funding Source <br />................. .......... .._............._...._. <br />Park Bond, RETIF, Regional Cities & Cumulative Ca ip tal <br />.v <br />452-1101-452.02&452.03, 429-1050-460.42-02, 201-1111- <br />Account No. <br />452.42-01, 407-1101-452.4201 <br />Amount.,.,�......_ <br />........................._............... �����._�.�..... <br />Terms of Contract <br />....__ .. �_... �m.................... <br />Purpose/Description <br />Approval of C.O. #3 <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion,., Non -Discrimination„ Non -Debarment, E-Vrif, Iran, etc. <br />red For Chance Orders On <br />Amount ofN increase Decrease w 147,758.58 <br />Previous Amount $ 17,746, 568.0­0 � .._................... <br />Current Percent of Change: 0.79% <br />New Amount $ 17,894,326..5.8..�.�.�....�.�........w... <br />Total Percent of Change: -4.91 % <br />Dispersal After Approval <br />Copy Original <br />w <br />❑ 0 <br />