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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/14/19 <br />Name <br />Kyle Silveus <br />Department <br />Engineering w <br />BPW Date <br />ONNNNWWIVP OPoI�tlNi <br />6/25/19 <br />��� iNNNR ALp»Y '9/ <br />Phone Extension <br />141111111mImlmlmlmlmmmlllRIIIIIImI�IIIImmIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIWVIVIVIVIVIVIVIWV�IWV�IWV�IWVIVIVIVIVIVIVIVIVIWVN'IWVIVIVIVIVWIVIVWIVIVIVIVIWVIVIVNWI <br />9083 <br />v�i iNO�if�YlvWivrlYl➢If�!"�V MIMIVW@IIWI <br />..._e_ q ' Re uuired Prior to Submittal to Board _�_�..�... ..._._.. <br />�o _ <br />Legal ❑ Attorney Name Clara McDaniels_....._..... <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 R Michael Schmidt <br />Check the Appropriate Item Type Required for All Submissions <br />H Agreement <br />❑ Professional Services <br />❑] Bid Opening <br />❑ Quote Opening <br />® Change Order No. 1 <br />], Ease/Encroach. <br />Other: <br />H Contract <br />Resolution <br />Bid Award <br />Quote Award <br />El C/O & PCA No. <br />❑ Traffic Control <br />Proposal <br />❑ Req. to Advertise <br />uired Information <br />❑ PCA <br />Company or Vendor Name Ancon Construction Company, Inc. <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Historic Leeper Park Improvements — Bid Packa e 1 <br />Project Number 118-010A <br />Addendum <br />❑ Title Sheet <br />Funding Source RW TIF Bond <br />Account No. 452-1101-452-31.02 <br />Amount $ 13,883.94 <br />......... .�.�.�.�.�.............................w�a�ww <br />Terms of Contract <br />Purpose/Description 2 Add'l Trees, Add I Casting replacement, Dewateri .... _ . <br />n fir 24"N pipe <br />replacement <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination„ NonDebarmentEVerif , Iran, etc. <br />�e oir+ed for Cyr a Order� <br />Increase $ 13,883.94 <br />El Amount of_._._............_____.�................,,,,_�......� . .... .. .� . �___ <br />Decrease $ <br />Previous Amount $$1,322m..0.1..2...9 <br />.7.............................................................................................................................�._......... �.�.�.�......... _ �,,, �,�. <br />Current Percent of Change: 1.06% <br />