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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/18/2019 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 02/26/2019 Phone Extension 5920 <br />000000o w ime�wwwwwwwwwww,w:�rmiu�a � �raw�mmwu�mu�w�wm!�mmdu�u�uu�w.�omomom���pmrram:��ir.Hu aa�uu�r mmmm�i�uuumumuumwu <br />__ ..., ._ tal to Board <br />Rewired Prior to Submit <br />Legal Attorney Name: <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 <br />F-1 Agreement Amendment <br />Professional Services <br />F] Bid Opening <br />n Quote Opening <br />Change Order No. 4 <br />0 Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />►ropriate Item Tvr)e - <br />(� Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. _ <br />❑ Traffic Control: <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 />Terms of Contract <br />Purpose/Description <br />d for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />uired Information <br />❑ PCA <br />Ziolkowski Construction, Inc. <br />roval of C.O. #4 <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E Verify, Iran, etc. <br />... <br />Required For Change Orders Only <br />Amount of ® increase <br />Decrease � $ 22,757��.00 <br />Previous Amount $ 3,667,.�.�.�.�.�.�..�6..........����� 859.00 <br />Current Percent of Change: 0.62% <br />New Amount $ 3,645„102.00 <br />Total Percent of Change 1.04% <br />....... .....ea�_w Dispersal AfterAcproval.. .... .m _�.� ........ <br />Copy <br />Original <br />® <br />❑ Steve Cox <br />® <br />_ <br />❑ Toddy Skwarcan <br />