Project Completion Affidavit - 2016 Downtown Parking Garage Improvements Project No 115-143 - Gibson Lewis LLC

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 01 /18/2019 Department Public Works Name Toy Villa Division/Bureau Engineering ....... ._..... _.w.... _... ..... BPW Date 02/12/2019 Phone Extension 5920 uuummmmmMM111um... ivwwrm�m oouommioio�uiuiuimmmuiuumm e.... r�aa r ��o ormn��auwrmr rr�uw.wuu v�ercam esuired Prior to Submittal to Board Legal ❑ Attorney Name: Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ .....�_._................. ........ .. Check the Appropriate Item Type Required for All Submissions Agreement El Contract 71 Proposal ❑ Addendum [J Professional Services El Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening El Quote Award El Change Order No. R C/O & PCA No. ® PCA Ease/Encroach. El Traffic Control: F-1 Other: Rggyired Information Company or Vendor Name Gibson -Lewis,, LLC �........ n Yes M No ❑ If Yes, Approved by New Vendor rc asin� ....__._._ B� MBE/WBE Contractor MBE/WBE Contractor Requested ❑ No ❑Yes Name of go_ mpa t � Project Name 2016 Parking Garage Improvements Project Number 115-143 Funding Source Major Moves ................... Account No. 412.0401.415.36.01 Amount $1,228,684.00 Terms of Contract Purpose/Description Project Closeout ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination,. Non -Debarment, E-Verify, Iran, etc. Required For Change Orders Onk _... Amount of EJ Increase w $ Decrease $ Previous Amount $ Current Percent of Change: % New Amount $ Total Percent of Change: % Disoersal After Copy Original ❑ ❑ ❑ ❑