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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/14/2019 <br />Name K Ire Silveus Department Engineering <br />BPW Date 10/22/2019 Phone Extension 9083 <br />NW1��i IWNR9YllFMNf�OW19P„4i'AMYfXfdYN �llldNNM@VW9W�bd'�tlu�MW6fW ,.F+Y1NJWir9UVUM WIIIIVW��WN'Ii4W°Yil�.i, ill/VIINL"wU�dllmi' ,, pA'W Ip9llll'�111�19111MIIYrWNNgN �ry�: <br />Required Prior to Submittal to Board <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 ❑ Michael Schmidt <br />Check the <br />E] Agreement <br />El Professional Services <br />Bid Opening <br />Quote Opening <br />® Change Order No. 1 <br />Ease/Encroach. <br />Other: <br />pro ruts Item Type <br />0 Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />ElC/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />J Proposal El Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />uired Information <br />❑ PCA <br />Company or Vendor Name Larson Danielson Construction Co. Inc. <br />New Vendor E] Yes F] No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Pulaski Park Improvements .................................. <br />Project Number 118-056 <br />Funding Source......RW...�T....�IF ................................... ..��_�___�... .............�— <br />Bond _ <br />Account No. 452-1....1...01-452.31-06.........................................................................................�.� . <br />Amount <br />Terms of Contract <br />..� ....... .. <br />Purpose/Description Time e... .. <br />xtension onlyd time for due to learestroom facility design anc <br />materials — 63 da s Completion Date of 12/20/19. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Non -Discrimination, Non -Debarment„ E rif I Iran, etc. <br />Required For Cau a Orders O <br />Amount of <br />Increase $.. .. .... �..�._ m................ ....� <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: L <br />New Amount $ <br />................... <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />El <br />❑ <br />El <br />❑ <br />0 <br />