Change Order No 1 - McKinley Avenue and Fremont Park Improvements Div B Project No 118-072 - Walsh & Kelly Inc

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 06/26/19 Name Alicia Czarnecki/Sue Ellen Doudrick Department Engineering BPW Date 07/09/19 Phone Extension 5903 m�uuwiwuurrrmnaru�rmm a�urmr��o�r�ou�m rwrs;�sm--��nrr��r �nmunx� � �mwmmno��,w�ummuuiuwuwuwuwuuiuuuiuuiuu�,uiuiu��r�—��n..��:.mummiuuwiw�u�uuuuwuuiuw�uiwiNuiur,�... Rewired Prior to Submittal to Board Legal ® Attorney Name Clara McDaniels Controller ® 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 ® Michael Schmidt �ITIT Check the Appropriate Item Type - Required for All Submissions A reem g ent ❑Contract 0 Proposal Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award [] Req. to Advertise ❑ Title Sheet Quote Opening Change Order No. Quote Award �� ❑ PICA ase/Encroach. ❑ Traffic Control ❑ Other: .... Required Information Company or Vendor Name _....._ _W.. .. Division B & Alt. B1 B2 B3: Walsh & Kelly, Inc., Inc. . New Vendor El Yes [I No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor F-1 MBE ❑ WBE MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Avenue and Fremont Park Improveme mm.ts McKinley n Project Number 118-072 Funding Source Account No. Amount-- .................................. �,�....................�. Terms of Contract _ ............- . Purpose/Description ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non Debarments ran„ etc. Required For CheNe Orders Only Amount of OX Increase $ 1,380 00 Decrease Previous Amount Current Percent of Change: New Amount Total Percent of Change: Copy Original ® ❑ Kara Bo $ 244, 540.00 0.56% $ 245,920.00 0.56% Dispersal After Approval