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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/31/2019 Department Admin & Finance <br />Name Adam Parsons ................�.m�_�.�_.....�.�.�.......���-��� Division/Bureau Central Services <br />....�........ <br />��..�....._.............. <br />BPW Date ................_... —..... �� ....._._......_....... <br />/2019 Phone Extension 9302 <br />.nnuWuN�riovi��rr�r��r <br />R cured Prior to Submittal to Board <br />—..,,....... _,�,_.,m,,,,,...,,,,...m....._ . —A w�� ��.— . ._....... <br />... <br />Legal ® Attorney Name: Clara McDaniels <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 />Purchasing <br />_A.m,.. toA priate m TPeReu�red fSubmissions <br />F] Agreement Amendment ContractProposal EAddendum <br />Ej Professional Services ❑ Resolution <br />-1 Bid Opening W�,A <br />rd ❑ Req. to Advertise E] Title Sheet <br />n Quote Openingward <br />E] Change Order No. C/O & PCA No. ❑ PCA <br />Ease/Encroach. F Traffic Control: <br />Other: <br />Company or Vendor Name Brown &_Brown General Contractors, Inc. <br />❑ Yes ® No w v ❑ If Yes, Approved_ ...................— . �... _. by <br />New Vendor Purchasing <br />MBE/WBE Contractor ❑ MBE 0 WBE <br />.. ..............................._ww— _._._._._......_....._ <br />MBE/WBE Contractor Requested No ❑ Yes Name of Comp�aa <br />__......... ..m........... <br />Project Name CCB Office Updates <br />Project Number 118 079 <br />Funding Source COIT • DCI Re <br />...................P Maintenance air & Maintena ...._ ......... ITITm <br />Account No. 404-0617-431.36-01 s 211-1001-430.36-01 <br />_—_�_......._....�_...__.�_�......�.�.�...._........�._ .......... <br />Amount $� <br />117,428 <br />Terms of Contract Lump Summmm ... <br />Purpose/Description U ate office layouts tommAF/HR/ITmmand mmmDCl <br />U Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Reaurr d for q ngq Orders, <br />Amount of ❑ Increase $ <br />ElDecrease $ ._........�—.....����.......�. �.��. .�m�—��......_.........._ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Chan e .... % <br />... _�...._................ �w. W........... ..._. <br />Dispersal After Approval <br />Copy Original <br />® E] Ben Dougherty — Deputy Controller, Admin & Finance <br />.. <br />® �...__.._..___� .._..�� ..�.._...�.���__..-. �.— ..� �....._.............................. .._�........—......_� <br />J' t�in Kain — Interim Directo <br />r, DCI <br />