Project Completion Affidavit - Ziker Sample St Building Restroom Remodel Project No 117-123A - Premier 1 Construction

Home Browse Search

BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 5/07/2019 Name _,,,Tqy Villa�mmmmy Department En ineerin BPW Date 5/14/2019 Phone Extension 5920 mu�mwmw.vw!m irmurmrr�nirammmmm�mmmmmmm��m�mmmm..owrrr�k�umu d w,�mmm� wmmam�nawre ...................... ...,..w.,,, �....�.�....._._�,....... Required Prior to Submittal to Board Legal 0 Attorney Name Controller D Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the Agreement Professional Services E] Bid Opening l Quote Opening ❑ Change Order No. Ease/Encroach. Other._ Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description )ro riate Item Type El Contract Resolution El Bid Award ❑ Quote Award El C/O &PCANo. _ ❑ Traffic Control for All Submissions I Proposal ❑Addendum ❑ Req. to Advertise ❑ Title Sheet Required Information Premier 1 Construction 7 Yes N_No _ ❑^If Yes, 7 MBE FM WBE Purchasin Ziker Samp�.l..e...�.�.�.S�....t_..r....ew_...e......t Building: Restroom mRmemodel mmmmmmmmmmmmmmmmmmmm_w 117-123A River West......................._................................w_______ m..,....�.�...................... TIF 324.1050.460.42.02 �..... �, �. $ 45,976.00 Proiect Closeout ❑ Required Contractor's Certification Form Attached (Non - Collusion„ Non -Discrimination, Non -Debarment, E-Verifv, Iran. etc. Required For Chane Orders On Amount of ❑ Increase ❑ Decrease Previous Amount $.... Current Percent of Change. % New Amount $ Total Percent of Change: % Dispersal After Approval Copy Original El ❑ ❑ ❑