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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/04/2019 <br />Name Toy Villa Department Engineering <br />BPW Date 06/11/2019 Phone Extension 5920 <br />...................� .w� .................................... <br />egwui red Prior to Submittal to Board <br />Legal E] Attorney Name <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 ❑ <br />Check the <br />LJ Agreement <br />0 Professional Services <br />F-1 Bid Opening <br />❑ Quote Opening <br />F1 Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />El <br />pepITate ItemwT� i"otod for All mSubmissions <br />EJ Contract ❑ Proposal E Addendum <br />❑ Resolution <br />❑ Bid Award ❑ Req. to Advertise ® Title Sheet <br />❑ Quote Award <br />Z C/O & PCA No. 8 Final ❑ PCA <br />El Traffic Control <br />Required Information <br />Rieth-Riley Construction Co., Inc, <br />Yes No E] If Yes, Approved by Purchasin <br />..7MBE l WBE <br />Project Closeout <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment„ E-Verif, Iran, etc. <br />Peqlred For Change Orders On <br />Increase $ 7,891.99 <br />��......_.......................................................... <br />Decrease $ <br />Previous Amount $ 3,469,972.80...............................______ <br />Current Percent of Change. 0.23% <br />New Amount $ 3,477,864.79 <br />Total Percent of Change: 7.73% <br />Dispersal After Approval <br />Copy <br />Original <br />El <br />El <br />