Substantial Completion Affidavit - Erskine Clubhouse Renovation Project No 116-108 - Ziolkowski Construction Co

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM / Date 6.4/19........... .._....�w Name Kyle,Silveus _ Department Engineerin BPW Date 6/11/19 n W�'MMWI�IIW'@'AVOVNNW'MMM9Y.�i�'.... Phone Extension 9083 �OIIDl69AAA �tl%% 9IWmWIVdffll GOgttIOAWYI � NM4 ...... .--_--- ......... ._...- Re aired Prior to Submittal to Board Legal E] 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 Typ Required" for All Submissions [� Agreement g � ...._____. Contract �] Proposal [� Addendum ❑ Professional Services E] Resolution E] Bid Opening El Bid Award ❑ Req. to Advertise ❑ Title Sheet F Quote Opening Quote Award 6 t� 5��n�.� � ❑ Change Order No. [ ] C/O & PCA No. VOCA ❑ Ease/Encroach. ❑ Traffic Control Other: _ Required Information Company or Vendor Name Ziolkowski Construction Inc. New Vendor �]' Yes Z No F If Yes, Approved by Purchasing MBE/WBE Contractor [:] MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Erskine Clubhouse Renovation Project Number 1� 16-108 Funding Source �...._.__............... .�........... ....m___� __........... ..................,.,.w.....___....... _....................................... Account No. Amount....................................__.......... Terms of Contract Purpose/Description Certificate of Substantial Completion n Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment„ E-Verify, Iran„ etc.L ....._____ ._ Required For Chan pie Orders Only Amount of �] Increase Decrease $ Previous Amount Current Percent of Change: ................. �_ ........� mm, ..............__ __... New Amount Total Percent of Change: Dispersal After Approval Copy Original El F]