Request to Advertise - Gemini Site Improvements Project No 119-043A

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 4/16/19 e Silveus Department Engineering BPW Date 4/23/19 Phone Extension 9083 _...... ................ ._.._ Required Prior to Submittal to Board Legal Attorney Name Clara McDaniels Controller Controller review is required for all Contracts $5,000.00 or more anc greater than one year in length per the City Purchasing Policy Purchasing ❑ Michael Schmidt Check the Appropriate Item Tpe — LJ, Agreement E Professional Services F_J Bid Opening El Quote Opening Change Order No. _ El Ease/Encroach. Other: LJ Contract E] Resolution E' Bid Award ❑ Quote Award ❑ C/O & PCA No. Traffic Control d for All Submissions _ Proposal ❑Addendum ® Req. to Advertise ❑ Title Sheet ired Information Company or Vendor Name TBD New Vendor Yes ❑ No [ MBE/WBE Contractor MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Project Name Gemini Site Imf Project Number 119-043A ❑ PCA If Yes, Approved by Purchasing Name of Company rovements Funding Source West Washington TIF Account No. 422-1050-460-42.02 Amount......�....T�B.D...._ �.....� �..........��_�W �,�............��..�... ..��...�....... �mm_ m.......... �W __ ... ....�.. - - - A. ..... ... Terms of Contract Base bid Purpose/Description Parki ng and Draina a Im p rovements to Gemini A a_ rtrent _Qom lex south of Colfax ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify,Iran etc.)._......... Required For Chan a Orders wOnly El crease $ °, *�tl Amount of �.._ .. �..r f" � � �- _.. El Decrease $ Previous Amount $ Current Percent of Change 0/0 �j t New Amount Total Percent of Change: % Dispersal After Approval Copy Original ❑ ❑,.