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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Auu.s.t....5..,.-20_1..9...... <br />......Rode <br />. . .......................... <br />Name r N awrot <br />Department Public Works <br />BPW Date 13,2019 wmnaumnmiwm„n�e:�veuHu Phone Extension 5932 <br />mmimimmmimimmmimimimimuuuuuuuuuuuuummmmmuuumuuuuuuuuuuuuwwuuumwmuuummwwoimmm <br />_._._.. _.. .............. .... ......... ......... <br />Required Prior to Submittal to Board ... _ _ ........... _ ._.............. <br />Legal ❑ <br />Attorney Name <br />Controller <br />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 />mmm mmmm m mmITmm Check the p mmropri t Item T. I e f /ro c for All Submissions <br />E] Agreement <br />El Contract El Proposal ❑ Addendum <br />❑ Professional Services <br />[❑ Resolution <br />Bid Opening <br />H Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Opening <br />R Quote Award <br />E Change Order No. <br />❑I C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach, <br />El Traffic Control <br />Other: _....... _ __....__......................... <br />mm��_.�..............__..Required <br />.,.._.. _._._._.. <br />Information <br />Company or Vendor Name <br />D.C. B rs Co./Det <br />mmm y Co./Detroit Inc. <br />New Vendor <br />If Yes, p a oved <br />Yes No I t Purchasing <br />MBE/WBE Contractor <br />mm _5 <br />MBE ®V1%mBE <br />MBE/WBE Contractor <br />Requested <br />El No El Yes Name of Com an <br />Project Name <br />Wa rune Street & Leighton Plaza Parking Structures Repairs 2019 <br />Project Number <br />119-048 <br />Funding Source <br />Parking parege Fund__.. <br />Account No. <br />'Vuy nm-601-0464 45.36 01 Leighton _._ m04 <br />601 62-645.36-01 <br />Amount <br />$368,330.00 <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />Wayne Street Garage Amount is $148,020.00 Leighton Plaza <br />Garage Amount is $220,310M <br />F] Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />�'.......:......... . = . .� <br />Required For Change Orders Only <br />Amount of FJ Increase <br />R Decrease <br />Previous Amount <br />$ <br />Current Percent of Change. <br />—. o�....................._.............�........... ............m.. � � w�....,u a �_...........� .................� <br />New Amount <br />TotalPercent of Change:........� <br />................�....�� �.�.�.�.�.�__�.�....�.�.�.�.�.�......�.�.�.�.�.�_...............................................................�.�.�.�.�.�.�.�.�.�_�_�.�.�.�.�.........�.....��w� <br />Dispersal After Approval <br />Copy Original <br />❑ El <br />❑ F <br />