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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />1/15/2019 <br />Kyle Silveus <br />Department Engineering <br />BPW Date 1/22/2018 Phone Extension 9083 <br />HNN <br />.... . .. ... <br />Required Prior to Submittal to Board <br />Legal E] Attorney Name Clara M�cDaniels <br />Controller El 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 F-1 Michael Schmidt <br />Check the <br />LJ Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />[J Change Order No. <br />[] Ease/Encroach. <br />FI Other: <br />iropriate Item Type...- <br />E] Contract <br />[:] Resolution <br />El Bid Award <br />El Quote Award <br />❑C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />I Proposal Pfl Addendum <br />El Req. to Advertise El Title Sheet <br />uired Information <br />E:1 PCA <br />Company or Vendor Name ACM Engineering and Environmental Services <br />New Vendor 0 Yes N No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE n WBE <br />MBEIWBE Contractor Requested E] No E Yes Name of Company <br />Project Name Erskine Clubhouse Renovation <br />Project Number 116-108 <br />Funding Source Golf Operations <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description O�d final P S",__AaDroved on 10/9if�:L�650now $4,139. <br />Amendment to Lead and Asbestos testing contract to test ljggjd in <br />two suspect fuel tanks at Erskine Golf Course, Liquids will be <br />tested for flashpoint, density, and reactive tesl!gg-to determine if fue <br />and type, <br />[:1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-yerify <br />Required For Chqp9e O�rd <br />Amount of increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />F1 Patrick Sherman <br />F .......... <br />❑ <br />El El <br />