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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/13/2019 <br />Name Sue Ellen Doudrick <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date 12/19/2019 Phone Extension 5922 <br />Required Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <br />Controller E] 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 />Check the <br />Agreement Amendment <br />Professional Services <br />El Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />El Ease/Encroach. <br />Other: <br />Michael Schmidt <br />�ro�riatemmmltem T <br />F1 Contract <br />Resolution <br />Bid Award <br />Quote Award <br />❑ C/O &PCANo <br />❑ Traffic Control:. <br />for All Submissions <br />C Proposal <br />❑ Req. to Advertise <br />Required Information <br />❑ PCA <br />Addendum <br />® Title Sheet <br />Company or Vendor Name HRP Construction Inc <br />❑ Yes ® No ❑ If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor E] MBE ❑ WBE <br />MBE/WBE Contractor Requested Name of Com a n... <br />yNo Yes.-._ ; _.. .. <br />Project Name SmallwDrainaae Design wand Repair - Sampson and Overlook <br />Project Number 118-063A <br />...S....�.�................._........ <br />�FundingSource LRoCa it <br />Account No. 251-0608-431.42-96..._....... ......_.— <br />------ <br />------------ <br />__ <br />Amount <br />� <br />�..._..........�..___..�-�_.._............_............��_._.......... <br />24,180 <br />Terms of Contract Award mof project as unit pricesmmmsubiect to easement acquisition <br />Drainage Improvements to Sampson Street and Overlook Court <br />Purpose/Description within the ROW and within easements. <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) qq <br />Required For Chan ...Orders Only_ ...........:. w _ ........ <br />Amount of l increase <br />crease $ <br />$ <br />_........................ <br />..... <br />........... - ... .............. _ _....._ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />° ._....... _........ .......... ....... <br />Total Percent /° of Change: <br />Dispersal After. pproval �....... <br />Copy Original <br />® Fj Kara Boyles <br />............. <br />® �] Sue Ellen Doudrick <br />El............__............ _ ......................... ._.... ...................-......-.._._._..................... <br />