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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4, 2019 <br />Name Becca Plantz <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date February 12, 2019 Phone Extension 5998 <br />Re aired Prior to Submittal to Board <br />Legal ❑ Attorney Name: Clara McDaniels <br />Controller j Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />Check the <br />Agreement Amendment <br />Professional Services <br />E] Bid Opening <br />El Quote Opening <br />® Change Order No. 2 <br />❑ Ease/Encroach.. <br />F� Other: <br />iro riate Item T _- <br />Contract <br />Resolution <br />Bid Award <br />El Quote Award <br />C/O & PCA No. <br />Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />for All Submissions <br />1 Proposal <br />❑ Req. to Advertise <br />ired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Peerless Midwest <br />E' Yes ❑ No El If Yes, Approved bv Purchasi <br />�] MBE WBE <br />�jNo 0 Yes Name of Coffin <br />Edison Production Well #2A Rehabilitation <br />.............__ww �� ....... �m_................. <br />Water Works O & M <br />620-0640-602.31.06 <br />Terms of Contract Lump —Sum <br />Purpose/Description Extending the completion date due to severe weather on 1/30/18 <br />and 1/31/18. <br />__.........._....... .__............... _. <br />❑ Required Contractors Certification Forms Attached (Non- .............. <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For C a m <br />Amount of Increase _.$.. __ .. .............ww� _._._..._...... <br />El Decrease $ -w <br />_.. _.�...�................. m <br />Previous Amount $ <br />Current Percent of Change; _... % <br />New Amount $ <br />................................. <br />Total Percent of Chang: mmmmm%ommm_ __m <br />..................... <br />.._.._ Disoersal After Armroval l <br />Copy <br />Original <br />® <br />❑ Becca Plantz <br />❑ <br />❑ .w.— w...............- w — <br />