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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/25/2019 Department Public Works <br />Name Toy Villa Division/Bureau Engineerin <br />g <br />BPW Date 05/14/2019 Phone Extension 5920 <br />Itr INI�NM VNIPYrMPoNMNWi�Nfl o�v ,�qpy�� p�!riVi �- �Rlmi�IlmImNINMIWIWV�IWWWVIVIVIVIVN'VWV!VIVNW� n gy��µ <br />�. ._._. _.... _..._.,,,, Required Prior to Submittal to Board <br />Legal F1 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 El <br />Check the <br />LJ Agreement <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No, <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />To riate Item Typ <br />F]I Contract <br />El Resolution <br />E Bid Award <br />❑ Quote Award <br />® C/O &PCANo <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 />—mitred for All Submissions <br />❑ Proposal <br />0 Req. to Advertise <br />2 Final ❑ PCA <br />uired Information <br />Rieth-Riley Co.,Inc. Construction I <br />Approval of C.O. #� <br />2 and Project Closeout................................__„y <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion Non -Discrimination Non -Debarment, E-Verify Iran, etc. <br />mired For Chanod Orders Only <br />Amount of E Increase �m5,42 Decrease $ 9.54 <br />Previous Amount $ 553,203.93 <br />Current Percent of Change; 0.98% <br />New Amount $ 547„774.39 <br />Total Percent of Chancre: 0.20% <br />rsal After <br />Copy <br />Original <br />❑ <br />❑ <br />El <br />M <br />