Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />4/16/19 <br />Silveus <br />Department Engineering .................m..........__ <br />BPW Date 4/23/19 Phone Extension 9083 <br />.. 1. WW,W'MM�'@'MIMIMIMI�M.9VWWWWWWWWWWWWWVIVIVN'VWIA�PtlIVIVPoWIVWW'i�Wl MIDI NIIIIIIIINIINIIIIIIIIIIINIIINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIW"J�IP.X�NMNI�W'AWPMf�MYY@f IDIDID1�flAY,GM�k,�iW�I�WMNI�IIWNRIp:�n!M�MI�F�40f9� <br />..........................�.......—.......—.... ....... .......... ........ �,..................mm........................... <br />Rquir�d .Prior to ITSubmittal to Board <br />Legal ❑ Attorney Name Clara McDaniels <br />Controller ❑ 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 Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />EJ Quote Opening <br />® Change Order No. 11 <br />El Ease/Encroach. <br />0 Other: <br />iro riate Item T e - <br />[:1 Contract <br />E] Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑C/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />I Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />ired Information <br />❑ PCA <br />Company or Vendor Name Ziolkowski Construction Inc. <br />New Vendor [] Yes E No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor [ ] MBE FWBE <br />MBEM/BE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Erskine 116-10Clubhouse Renovation <br />ProjectNumber 8..............................�..�.m.............................................. ..._...._ <br />Funding Source <br />Account No. <br />Amount N/A <br />Terms of Contract <br />Purpose/Description Time Extension for Misc. Unforeseen Conditions — 63 Calendar <br />Days Moves Substantial Completion to 5/24/19 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-)/eify, Iran, etc. <br />Required For Change Orders Only _. <br />Amount of ❑ Increase N/A <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change, N/A aaa �a <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kyle Silveus <br />® ❑ Patrick Sherman....................................�.....�.�..........�. <br />