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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 23, 2019 <br />Name Roger T. Nawrot <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date October 8, 2019 Phone Extension 5932 <br />_.. w <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name: ..��._-_............. ...�........ .......��... <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />PurchasinEl <br />g <br />Wm Check the <br />LJ Agreement <br />El Professional Services <br />El Bid Opening <br />❑ Quote Opening <br />® Change Order No. 1 <br />EJ Ease/Encroach. <br />F1 Other: <br />brppnqte Item T e - Requ <br />Contract <br />Resolution <br />❑ Bid Award <br />EJ Quote Award <br />El C/O & PCA No, <br />El Traffic Control: <br />for All Submissions <br />Proposal <br />0 Req. to Advertise <br />Retuired Information <br />PCA <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name <br />Walsh & Kelly,, Inc. <br />_ <br />0I Yes Z No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing .��..��......... <br />MBE/WBE Contractor <br />[. <br />_,m ..-_ _____ .. <br />M B E W B E <br />MBE/WBE Contractor Requested <br />❑ <br />.....__._ <br />No L1 Yes Name of Comrun <br />.�.� m <br />Project Name <br />Michigan Street Reconstruction <br />Project Number <br />118-075 <br />Funding Source <br />............................... ..�...... .........�..........�......................www �.�..........�.�.�........ _.�....�. <br />RWDA <br />Account No. <br />324.1050.460.42-03 <br />Amount <br />� 2_5,i�� "._.�� Total Amoun_ ........ _- .......�.................._ <br />$25,195.6 ............................... t- 1,937, 594.60 <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />..�foundations $11,847.00 <br />Wayfinding sign <br />Base Bid items $13,348.60 <br />Required Contractor's Certification Forms q Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />ww..... ......._ _ . <br />Required For Change_Orders Only <br />Amount of <br />❑ Increase $ 25,195 60 _ .............. <br />❑� Decrease $ <br />Previous Amount <br />$ 1,912399.00 <br />Current Percent of Change: <br />1 .32% <br />New Amount <br />......$....1...937,594. .........__Y_�,,,.................�...................�________ <br />........._ 60 <br />Total Percent of Chance: 1.32% <br />Disoersal After Aooroval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />