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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />February 4, 2019 <br />Becca Plantz <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date February 12, 2019 Phone Extension 5998 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: Clara McDaniels <br />Controller El 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 />E] Agreement Amendment <br />El Professional Services <br />F-1 Bid Opening <br />M Quote Opening <br />Change Order No. 2 <br />Ease/Encroach, <br />M Other: <br />Iro ; <br />Ltatq.1tern Type :7 eAi <br />El Contract <br />[:] Resolution <br />El Bid Award <br />El Quote Award <br />F-1 C/O & PCA No, <br />F-1 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 />] Proposal <br />E] Req. to Advertise <br />Information <br />El PCA <br />Addendum <br />El Title Sheet <br />Peerless Midwest <br />F] Yes 0 No E] if Yes, Approved by Purchasin <br />_p <br />MBE WBE <br />❑ No 0 Yes Name of Compa <br />ny <br />Olive Production Well #6 Rehabilitation <br />118-102 <br />Water Works 0 & M <br />620-0640-602.31.06 <br />Terms of Contract Lump Sum <br />Purpose/Description Extending the completion date due to severe we on 1/30/18 <br />and 1/31/18. <br />❑ .................... ...... ..... ­­­ . . . . ............... <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />�Rqq fired For,C an e Orders,O I n! <br />Amount of F] increase . . . . ....... . ................... <br />1:1 Decrease <br />Previous Amount <br />. ............. ..... <br />Current Percent of Change* % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After App <br />. . . ............. <br />Copy Original <br />F1 Becca Plantz <br />— - - - ----------------- <br />El <br />El El <br />