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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date _5/7/19_ <br />Name We...Silveu............................................_...................�......................m.._ <br />BPW Date 5/14/19 <br />Department E n m eenn <br />P ..........������� ..��.. <br />�...... De �� ...... .�...-........... <br />Phone Extension 9083 <br />nWm <br />Required Prior to Submittal to Board <br />Legal <br />Attorney Name Clara McDaniels <br />Controller El <br />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 <br />Michael Schmidt <br />.._ .... ................... _......... _........ ....... . .. _— <br />Check the A ra?p i tw Item ITTyp guired for All Submissions <br />....._.......-.�...._.................... ..-.. _ ._.. <br />Agreement <br />El Contract F Proposal Addendum <br />0 Professional Services <br />❑ Resolution <br />Bid Opening <br />E Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />F] Quote Opening <br />0Quote Award <br />Z Change Order No. 12 <br />0 C/O & PCA No. ❑ PCA <br />El Ease/Encroach. <br />Traffic Control <br />E] Other: <br />......... ............. ._. ......_.... ....... <br />__� ... e4 gJreq.1nformation <br />Company or Vendor Name <br />Ziol'kowski Construction Inc. <br />New Vendor <br />El Yes Z No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Erskine Clubhouse Renovation �_. <br />.r.........,, �_........ _..... <br />Project Number <br />116-108 <br />Funding Source <br />Account No. <br />Amount <br />$9,811.00 <br />Terms of Contract <br />Purpose/Description Cost for removal of fuel in fuel tanks revised mechanical room <br />intake duct routing, front porch concrete step replacement, and <br />other miscellaneous items <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion„ Non -Discrimination, Non -Debarment„ E-Verity, Iran, etch <br />Required For Chancie Orders Onl <br />Amount of ® Increase $9,811.00 <br />❑ Decrease $ <br />Previous Amount $1,091,531.00 <br />Current Percent of Change: 0.90 _ <br />New Amount $1,101,342.00 <br />Total Percent of Change: 21.43% <br />Dispersal After Approval <br />Copy Original <br />® Kyle Silveus <br />® ❑ Patrick Sherman <br />❑.............__m_—._�_................ <br />