HomeMy WebLinkAboutRequest to Advertise - Ameritech Drive Pavement Improvements Proj No 117-057ABOARD OF PUBLIC WORKS
AGENDA ITEM RE, VIEW REQUEST FORM
Date April 30, 2018
Name Roger Nawrolt
Department
Division/Bureau
Public Works
BPW Date May 8, 2018 Phone Extension 5932
Required Prior to Submittal to Board
Legal Attorney Name: Clara McDaniels
Controller ❑ Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing N
Check the Appropriate Item Type - Required for All Submissions
Agreement El Contract El Proposal _E] Addendum
Professional Services F-1 Resolution
❑ Bid Opening ❑ Bid Award Req. to Advertise E] Title Sheet
❑ Quote Opening ❑ Quote Award
F-1 Change Order No. El C/O & PCA No.. E] PCA
El Ease/Encroach, El Traffic Control:
R Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBEIWBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
uired Information
El Yes E:1 No F] If Yes, Approved by
Purchasing_
E] MBE [:1 WBE
El No L1 Yes Name of Company
Ameritech Drive Pavement Improvements
River West TIF
324-1050-460.31-20
Not to Exceed
F] Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Amount of LJ Increase $ APPROVID,
F-1 Decrease $ M—W4 Of hmic work's
Previous Amount
Current Percent of Change: % ZdAJT,",� 9-11 1, &S
New Amount
Total Percent of Change:
$
%
I
Dispersal After Approval
Copy Original
El F-1
F-1 F]
R F-1